The a-to-z-of-skeletal-muscles

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The a-to-z-of-skeletal-muscles

  1. 1. The A to Z ofSkeletal Muscles Dr A. L. Neill BSc MSc MBBS PhD FACBS medicalamanda@gmail.com
  2. 2. ©D rA ma na da Ne ill
  3. 3. The A to Z of Skeletal MusclesIntroductionThis is the fourth revision of the first A to Z book, and many things illhave changed. The clinical aspects of muscle grouping and testinghas been expanded, due to strong feedback, but the listing of themuscles and their illustration are largely unchanged. NeThere are now 7 in the A to Z series of pocket-sized medical referencebooks (see the back of the book for details) - 2 considering organs ofthe body, and also 2 posters on medical education on with supportivewebsite, where all the A to Z material can be accessed as well asadditional material: www.aspenpharma.com.au/atlas/student.htmAny corrections b/n reprints are placed on this site so that the latestversion and comments re any of the A to Z books may be viewed assoon as possible. daAs usual the A to Zs get better if there is feedback – please sendus your comments and suggestions. naAcknowledgementThank you ASPENpharmacare Australia for your support & assistance inthis valuable project, particularly Mr. Greg Lan CEO of AspenpharmacareAustralia, Rob Koster, Richard Clements and Ante Mihaljevic of TM maGraphic Design & everyone who provided valuable feedback.DedicationTo AA and ZZ I love you. rAHow to use this bookThe structure of the A to Z books grows and develops with eachpublication, but the principle of listing structures in an alphabeticalmanner as far as possible and hence making the book its own indexfor easy retrieval has been maintained. However this is now doneafter first dividing the material into a number of main topics for©Dexample muscle groups acting on significant joints, examination,palpation and testing of muscle groups prior to the main listing ofeach and every muscle - excluding some of the detailed Head andNeck muscles which can be found in the A to Z of the Head & Neck.1 © A. L. Neill
  4. 4. The A to Z of Skeletal MusclesFeatures are named using in the most familiar terms and thoseagreed upon by anatomical nomenclature convention avoiding illeponymous terms wherever possible but as with all anatomicalstudies sometimes several terms are used to name the same feature.Wherever this is common and to save confusion reference is made toeach term. Similarly between disciplines such as radiology and Neosteology as well as anatomy the same view may be describedseveral different ways, so when this is also common and to provideclarity these terms are mentioned. In some cases with complexmuscles - several views of the same muscle are also supplied.The text under each muscle in the main listing consists of basic daminimal information such as the : Origin (O), Insertion (I), Action (A),Blood Supply (BS), Nerve Supply (NS), Nerve Root origin (NR) andfunctional tests (T).The test section is by no means complete, although in this edition ithas been added to in the front of the book with illustrations of testing naof major muscle groups. It is also expanded in the A to Z ofPeripheral Nerves and will be further explored in the A to Z ofmuscle and PN testing.Capitalization is used to demonstrate the muscles and bones and maimportant components.It is hoped that this will prove a valuable resource for those workingon muscle examination exercise and recovery in whatever field.Any suggestions on format or inclusions will be gratefully receivedThis book is cross-referenced with all the other A to Zs rAThank youAmanda NeillBSc MSc MBBS PhD FACBS©DISBN 978 0 9806959 6 0© A. L. Neill 2
  5. 5. The A to Z of Skeletal MusclesTable of contents illIntroduction 1Acknowledgement 1Dedication 1 NeHow to use this Book 1Table of Contents 3Abbreviations 4Common Terms Used in the Study & ExaminationDefinition of Tendons & Ligaments na daof Skeletal Muscles, Nerves & BonesStructure & Substructure of Skeletal Muscles 5 11 10Neuro-Muscular Junction 13Neuro-Muscular Spindle 15Neuro-Tendinous Spindle 15Anatomical Planes & Relations 17 maAnatomical Movements 19Classification, Naming & Examination of Muscles 25Myotomes 27Muscle Innervation at the Spinal Cord level 28 rASegmental Motor Nerve Diagram 33Summaries Of Skeletal Muscle Groups 35Examination of Skeletal Muscles - major groups 61©DIndex - Alphabetical Listing Of Muscles 693 © A. L. Neill
  6. 6. The A to Z of Skeletal Muscles LL = lower limbAbbreviations lig = ligamentA = actions /movements of ill LP = lumbar plexus a joint Lt. = Latinaa = anastomosis or anastomoses MC = metacarpal / metacarpo-adj. = adjective (hand) Neaka = also known as MCP = metacarpo-phalangealALL = anterior longitudinal ligament med = medialalt. = alternative MT = metatarsal / metatarso (foot)ant. = anterior N = nerveart. = articulation (joint w/o the NR = nerve root origin additional support structures) NS = nervous supply / nerveAS = Alternative Spelling, generally system referring to the diff. b/n NT = nervous tissue (of hip bone)b/n = between da British & American spellingASIS = anterior superior iliac spine O P pl. = origin = phalangeal / phalanges / phalango- = pluralBP = brachial plexus PLL = posterior longitudinal naBS = Blood Supply ligamentC = cervical PN = peripheral nervec.f. = compared to post. = posteriorCN = cranial nerve R = right / resistanceCNS = central nervous system ROM = range of motion maCo = coccygeal S = sacralCP = cervical plexus sing. = singularcollat. = collateral SC = spinal cordCSF = Cerebrospinal fluid SN = spinal nerveCT = connective tissue SP = spinous process / sacrale.g. = example plexusEC = extracellular (outside the cell) SS = signs and symptoms rAES = Erector Spinae group of T = TEST / thoracic muscles TOS = thoracic outlet syndromeext. = extensor (as in muscle to TP = transverse process extend across a joint) UL = upper limb, armGk. = Greek VB = vertebral bodyI = insertion VC = vertebral columnIC = intercarpal / intercarpo - (b/n w/n = within©D wrist) w/o = withoutIMC = intermetacarpal wrt = with respect toIP = interphalangeal (b/n fingers / & = and toes)IT = intertarsal / intertarsojt(s) = joints = articulationsL = lumbar / left© A. L. Neill 4
  7. 7. The A to Z of Skeletal MusclesCommon terms in the Study and Examination ofSkeletal Muscles, Nerves and Bones illAla wing used for winglike process e.g. on the hip boneAnkle bend ie the “bend” b/n the leg and footAnte before - in front ofAperture an opening or space between bones or within a bone NeAponeurosis expanded end of a tendon - sheet of fibrous tissue allowing for muscle insertionAppendicular (skeleton) that which is not axial i.e. the upper and lower limbsAreolar air filled bone - tooth socketArticulation joint, which is a point of contact b/n 2 opposing bonesAxial (skeleton) refers to the head & trunk (vertebrae, ribs & sternum) of the body.Basilar relating to the base or bottom of structuresBasocraniumBrachiBrevisBuccal base of the skull da pertaining to the arm (upper arm) short relating to the cheekCanal tunnel / extended foramen naCapitus/Caput relating to the headCarpi/Carpo- relating to the wristCarotid “to put to sleep” related to the carotid BVs in theneck which when compressed can put a person to sleepCavity/Cavernous an open area or sinus w/n a bone or formed by 2 or more bones - used interchangeably with fossa. maCephalic/Cephalo- pertaining to the headCervical/Cerivco- pertaining to the neckCilli/Cillia pertaining to the eyelash / hairColles referring to the “collar” or neckCochlea a snail, snaillike relating to the organ of Corti in theearCondyle a rounded enlargement / process possessing an rA articulating (joint) surface.Cornu a horn as on the Hyoid boneCorona 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 ribsCranium / Cranus the cranium of the skull comprises all of the bones of©D the skull except for the mandible, referring to theskull generally excluding the facial bonesCrest prominent sharp thin ridge of bone formed by the attachment of muscles particularly powerful ones eg Temporalis / Sagittal crestCuneate / Cuneus a wedge / wedge-shapedCutus referring to skin, hence cutaneous branches of Ns go to the skinDeltoid D-Shaped5 © A. L. Neill
  8. 8. The A to Z of Skeletal MusclesDens / Dentine / Dentate a tooth, relating to teeth, denticulate having tooth-like projections (see odontoid)Depression a concavity on a surface illDiaphragm a partition or separating wallDiaphysis 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 NeDislocation a displacement of anything particularly bone (also called luxation)Distal further away from the core opposite to ProximalDorsal / Dorsi relating to the back or the back of something e.g. the handElbow any bend in the arm referring to the elbow b/n arm and forearmEminence a smooth projection on a bone.Epi-EpiphysisFacet da on top of the end of a long bone beyond the growth plate (epiphyseal plate) - 2 epiphyses to each long bone. a face, a small bony surface (occlusal facet on the chewing surfaces of the teeth) seen in planar joints.Femoris pertaining to the thigh naFissure a narrow slit or gap from cleft.Foramen a natural hole in a bone usually for the transmissionof blood vessels and/or nerves. (pl. foramina).Fornix an archFossa a pit, depression, or concavity, on a bone, or from ma several bones as in temporomandibular fossa - more like a “bowl” than a cavityFovea a small pit (usually smaller than a fossa) - as in the fovea of the occlusal surface of the molar tooth.Fracture break # particularly of boneGenio/Genu pertaining to the kneeGeneio pertaining to the chin adj. geneioGlossus / Glosso pertaining to the tongue rAGluteal / Gluteus pertaining to the buttocksGroove long pit or furrow, as on the HumerusHamus a hook hence the term used for bones which “hook around other bones or where other structures areable to attach by hooking - hamulus = a small hook.Hyoid U-shaped©DIncisura 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 skulloften 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 6
  9. 9. The A to Z of Skeletal MusclesLesion deficit or injury - lack of function arising from pathologyLigament fibrous tissue joining bone to boneLinea a line as in the nuchal lines of the Occiput, linea ill aspera of the FemurLingual pertaining to the tongueLip projection over the usual margin - e.g. the Glenoid lip (often pathological) NeLocus a place (c.f. location, locate, dislocate).Longus longLumbar back - generally the lower part of the back (lumbago)Magnum large pl magnaMandible from the verb to chew, hence, the movable lower jaw; adj.- mandibular.Mastoid a breast or teat shape - mastoid process of the Temporal bone.MaxillaMeatus maxillary. da the jaw-bone; now used only for the upper jaw; adj.- a short passage; adj.- meatal as in external acoustic meatus connecting the outer ear with the middle ear.Medulla middleMental relating to the chin (mentum = chin not mens = mind) naMetaphysis the slightly expanded end of the shaft of a bone.Mylo- relating to the molar teeth (from grinding as in a mill)Notch an indentation in the margin of a structure.Nucha the nape or back of the neck adj.- nuchal.Oblique / Obliquuis pertaining to a slope or slant e.g. muscles slanting ma downwards etcOcciput the prominent convexity of the back of the head Occiput = Occipital bone adj. occipitalOculus / Ocular an eye / relating to an eyeOdontoid relating to teeth, toothlike see DensOmo- pertaining to the shoulderOrbit a circle; the name given to the bony socket in which the eyeball rotates; adj - orbital. rAOrifice an opening.Oris / Ora relating to the mouthOs / Osseus / Ossei a bone / bonelike, referring to boneOstium a door, an opening, an orifice.Ovale Oval shapedPalate a roof adj.- palatal or platatine.©DPalm / Palmar referring to the palm of the hand - anterior in the anatomical positionPalpebra pertaining to the eyebrowParietal pertaining to the outer wall of a cavity from paries, a wallParotid pertaining to a region beside or near the earPars a part ofPectus/ Pectorial referring to the anterior wall of the chest / breastPennate resembling a featherPeroneus referring to the lower leg adj. - peroneal7 © A. L. Neill
  10. 10. The A to Z of Skeletal MusclesPhalanx/Phalanges small bones of the fingers or toes - 3/finger (2/thumb 2/big toe)Piriform pear shaped illPlantae referring to the sole of the foot adj - plantarProcess a general term describing any marked projection or prominence as in the mandibular process.Prominens a projection NeProne to place face down, or lie on the anterior surface (opposite supine)Pterygoid wing-shapedPubis/Pubic “hairy”, pertaining to the hairy part of the hipQuadratus square or rectangular shapedRadial/Radialis pertaining to the radial or lateral bone of the forearmRecess a secluded area or pocket; a small cavity set apart from a main cavity.RectusRhomboidRidgeRisorius da straight - erect rhomboid shaped (squashed, leaning square) elevated bony growth often roughened. laughter, smileRoot the segments of origin as in Nerve Root (NR) of the Peripheral Nerve made up from several points of exit na from the SCRotundum roundSagittal an arrow; the sagittal suture is notched posteriorly, making it look like an arrow by the lambdoid sutures.Salpingo pertaining to a tube maScalene uneven, one side very different to the otherSesamoid grainlikeSigmoid S-shaped, from the letter Sigma which is S in Greek.Sinus 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, rA venous or arterial blood, lymph or serous fluid depending upon location and health of the subject adj.- sinusoid.Skull the skull refers to all of the bones that comprise the head.Spine a thorn - descriptive of a sharp, slender©D process / protrusion. adj. - spinousSplanchocranium 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.Subluxation partial dislocation of bone, generally in the VC, usedto account for any mechanical impediment to N functionSulcus long wide groove often due to a BV indentationSupine to place face up or to lie on posterior surface (opposite prone)© A. L. Neill 8
  11. 11. The A to Z of Skeletal MusclesSuture the saw-like edge of a cranial bone that serves as joint between bones of the skull.Stylos an instrument for writing hence adj. - styloid a ill pencil-like structure.Symphysis a joint or a growth with bone-cartilage-bone connection e.g. in pubic symphysisTarsus / Tarsal pertaining to the Tarsal bone and the bones distal to it Ne in the foot (not the toes - phalanges)Temporal refers to time and the fact that grey hair (marking the passage of time) often appears first at the site of the temporal bone.Tendon fibrous end of a skeletal muscle facilitating attachment to bone (as opposed to ligament joining bone to bone)Tensor to stretch (i.e. muscle to stretch so that a structure is “tense”)TentoriumTeresThenarThorax a tent. round shape da relating to the palm as in thenar eminence referring to the chest region - anterior the area b/n the neck and the abdomenTrabecula a “little” beam i.e. supporting structure or strut pl. na trabeculaeTrapezoid trapezius or kite shapeTrochanter small wheel or disc-shaped as the disc shape of the trochanters of the FemurTrochlear pulley that part of the bone/ligament which pulls ma bones in another direction e.g. in the elbow and ankleTrunk 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)Tubercle a small process or bump, an eminence..Tuberculum a very small prominence, process or bump. rATuberosity a large rounded process or eminence, a swelling or large rough prominence often associated with a tendon or ligament attachment.Tympanic pertaining to a drumUncus a hook adj. - uncinate.Vagina a sheath; hence, invagination is the acquisition of a©D sheath by pushing inwards into a structure, and evagination is similar but produced by pushing outwards adj. - vaginal.Velum / Veli pertaining to a veilVolar pertaining to the sole (foot) or palm (hand)Zygoma a yoke, hence, the bone joining the maxillary, frontal, temporal & sphenoid bones also referring to the "H" shape of the bone. adj zygomatic.9 © A. L. Neill
  12. 12. The A to Z of Skeletal MusclesDefinition of Ligament and Tendon illLigament (2)= CT band which joins the muscle (1) to the bonealso used to describe any non-specific thickening of CT in organs andother structures - may incorrectly be used in this senseinterchangeably with Tendon NeTendon (3)= - CT band which joins 2 bones over a joint or 2boney points - used for joint stabilizationto limit the ROM of the joint as in the Knee na da 1 ma rA 2©D 3© A. L. Neill 10
  13. 13. The A to Z of Skeletal MusclesStructure and Substructure ofSkeletal muscles ill 1 muscle eg. Biceps Ne 2 epimysium - CT surrounding a whole muscle 3 perimysium - CT surrounding a muscle fascicle 4 endomysium - CT surrounding each muscle fibre 5 muscle fibre 6 nucleus (note the muscle cell is multinucleated) 7 8 9 myofibril da sarcolemma - membrane around each myofibril sarcomere basic contractile unit of the muscle na 10 myosin filament 11 actin filamentA band - myosin to myosin filaments maH band - myosin only segments minimum in contractionI band - actin only segment maximum in relaxationZ line - line of attachment of the actin filaments rA©D11 © A. L. Neill
  14. 14. The A to Z of Skeletal Muscles ill 1 Ne 2 3 4 na da 7 6 5 8 2 I A ma 9 H rA Z H©D A 11 10© A. L. Neill 12
  15. 15. The A to Z of Skeletal MusclesNeuromuscular Junction –Nerve end attaching to Skeletal muscle illlongitudinal 1 axon - sheathed Ne 2 mylein sheath – multiple lipid layers 3 Schwann cell 4 axonlemma – axon membrane 5 pre-synaptic vesicles 6 axon – unsheathed / naked 7 presynaptic membrane da 8 junctional folds (in sarcolemma) 9 synaptic cleft (~20nm) na 10 mitochondria 11 sarcolemma 12 myofilaments in muscle fibre ma rA©D13 © A. L. Neill
  16. 16. The A to Z of Skeletal Muscles ill Ne I 2 3 4 5 6 11 na da 10 7 ma 9 8 rA 12©D© A. L. Neill 14
  17. 17. The A to Z of Skeletal MusclesNeuro-Muscular Spindle –feedback loop to stop overextension in Skeletal illmuscle NeNeuro-Tendinous Spindle –feedback loop to tendon 1 capsule of spindle 2 myelinated motor fibres 3 myelinated sensory fibres 4 unmyelinated motor fibres 5 annualospiral fibre endings na da 6 bag of nuclei in intrafusal muscle 7 motor end plates 8 muscle fibres i = intrafusal e = extrafusal 9 skeletal muscle nuclei ma 10 tendon fibres i = intrafusal e = extrafusal 11 naked axons 12 nuclei in tendon rA©D15 © A. L. Neill
  18. 18. The A to Z of Skeletal Muscles I ill 8e 3 2 Ne 7 4 6 5 na da 6 8i 7 9 7 ma 8 9 rA 10 12©D I 2 7 11 10e 10i© A. L. Neill 16
  19. 19. The A to Z of Skeletal MusclesAnatomical Planes and RelationsThis is the anatomical position. illA = Anterior Aspect from the front Posterior Aspect from the back used interchangeably with ventral and dorsal respectivelyB= Lateral Aspect from either side NeC = Transverse / Horizontal planeD= 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 = adductionE = Coronal planeF = Median na da ma rA©D17 © A. L. Neill
  20. 20. The A to Z of Skeletal Muscles ill Ne na da ma rA©D© A. L. Neill 18
  21. 21. The A to Z of Skeletal Muscles Anatomical Movements ill Ne arm extension in sagittalplane / shoulder movement arm abduction -away from median na da plane / adduction-towards the median plane -shoulder movement shoulder extension in the sagittal plane ma shoulder abduction in the coronal plane (with elbow flexion) rA wrist extension©D wrist flexion shoulder elevation - reverse movement shoulder depression shoulder movement 19 © A. L. Neill
  22. 22. The A to Z of Skeletal Muscles ill Ne back extension / hyperextension note the back muscles are contracting na da hip flexion / with back and shoulder extension ma rA©D back lateral flexion shoulder back rotation extension and elbow flexion© A. L. Neill 20
  23. 23. The A to Z of Skeletal Muscles ill Ne neck flexion na da neck extension/hyper-extension lateral flexion ma rA lateral rotation©D note: extension of the neck is in the normal anatomical position21 © A. L. Neill
  24. 24. The A to Z of Skeletal Muscles ill Ne na da ma arm/shoulder movements in the coronal plane commencing from adduction abduction to extension rA shoulder/scapula movements in©D the horizontal plane© A. L. Neill 22
  25. 25. The A to Z of Skeletal Muscles ill Ne Hip flexion Hip extension na da Hip abduction Hip adduction ma rA Hip lateral and medial rotation Hip circumduction©D Knee flexion Knee extension23 © A. L. Neill
  26. 26. The A to Z of Skeletal Muscles ill Ne Foot dorsiflexion Foot plantar flexion Foot inversion Foot eversion na da Foot normal position Fingers extension Fingers flexion ma rA Forearm pronation Forearm supination Hand deviation radial/laterally ulna/medially©D Fingers abduction Fingers adduction Thumb opposition© A. L. Neill 24
  27. 27. The A to Z of Skeletal MusclesClassification, Naming & Examination of MusclesThere are 3 types of muscle tissue and this book discusses only one of them illSKELETAL MUSCLE. The other 2 are smooth muscle (for the gut and otherareas of involuntary movement) and cardiac muscle (for the heart). NeSKELETAL muscle is defined as muscle which is “striated” or striped,indicating and ordered cell structure, of myosin and actin filaments, and isgenerally under voluntary control, which has an action on the skeleton orbones in the body.In its relaxed form the muscle is at its maximum length and this is generallyhow the tissue is found. Stimulation generally causes contraction and ashortening and thickening of the tissue. As it is attached to a minimum of 2points, the Origin (O) and the insertion (I) - although these may be arbitrarily danamed - this “contraction” brings these 2 points closer together. To reversethis, another muscle must be attached to 2 different points which when theymove together cause a reversal of the position of the 2 or more affectedbones, hence for each muscle there is an antagonist (opposing muscle) and inmany situations a synergist (a muscle which enhances the original namovement).There are a few exceptions to this, for example SPHINCTERS are circulargroups of muscle fibres which upon contraction close the circle they haveformed and may not be attached to bones at all. Their function is to prevent maleakage or passage of material from one area to another.Many of the MUSCLES OF FACIAL EXPRESSION are inserted into the deepfascia of the skin and hence change the soft tissues of the face but do notaffect the bones underneath. We as humans have a great deal of thesemuscles, and they may be shifted or injured in many cosmetic proceduresbecause of this structure. rAMuscle are shaped to allow their contraction to occur in the most efficientmanner, for example sheets of muscles cover expanses of tissue to containthem, as in the OBLIQUES to contain and move bulky abdominal contents, orDIAPHRAGMS to separate as well as move large anatomical regions around,while TERES muscles are small, cordlike, focused groups of fibres for veryspecific movements.Generally the smaller the muscles the deeper they are placed so larger and©Dmore powerful muscles ones can cover them, for example the GLUTEAL andADDUCTOR group of muscles in the leg and buttocks. Smaller musclesgenerally have more specific actions, are more resilient but are weaker, theycontract and relax repeatedly for example, to maintain posture or balance, asin the ROTATORES. Larger, longer muscles by definition cannot be as precisebut have larger ranges of motion and more power and are placed moresuperficially - closer to the surface, as in ERECTOR SPINAE.25 © A. L. Neill
  28. 28. The A to Z of Skeletal MusclesFibrous tissue inserts give the muscle more strength but less ability to move,as in RECTUS ABDOMINUS versus TRAPEZIUS, but it is these large illsurface/superficial muscles whose shape can be changed and defined bygross movement exercises.Muscles are named using many different criteria singly or in combination: for Neexample they may be named according to their action –Supinator, Pronatorand size – Adductor Magnus, Adductor Longus, Adductor Brevis; their shapeand 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 doesnot seem to be a consistent pattern in this naming - only that from the nameit is often possible to determine their site, action &/or shape and this helpswhen memorizing these muscles. daBetween each muscle group is a fascial layer to transport in the BVs and theNerves but there is considerable variation in individuals so that in some casessome anatomists have named the same muscle in several ways. Thecommonest has been used here but the alternatives listed if it is thought there namay be confusion this for example ROTATORES has been listed as a singlemuscle group but may in some books be divided into 2 ROTATORES LONGUSand BREVIS, similarly with PSOAS which can be PSOAS MAJOR and MINOR,but not with PECTORALIS MAJOR and MINOR, 2 distinct muscles. Whereverthis occurs it is mentioned in the text, particularly if there is a functional madifference in the 2 muscles.Testing of a muscle is often impossible to do singly and they must be testedas 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 themuscle can overcome Gravity often a natural form of resistance to the muscleaction. This level of testing muscles is not dealt with in this book and will be rAdiscussed in the A to Z of Muscle and Sensory testing to follow - it is alsoexamined in some detail in the A to Z of Peripheral Nerves - howevertesting of the primary action of most muscles is listed on each page as aguide to the practitioner for basic testing and grouping of muscles. Please usethis testing section as a guide only.©D© A. L. Neill 26
  29. 29. The A to Z of Skeletal MusclesMyotomes illEach muscle is supplied by a particular NR or segment of the SC and themuscles supplied by the same NR belong to the same MYOTOME. These arebriefly grouped as follows. NeC1,2 neck and upper VC musclesC3-5 diaphragmC5 shoulder and upper armC6 wrist extensionC7 extension of the elbowC8 finger movementT1 finger abductionT1-12 chest and abdominal musclesL1,2 hip flexion daL3 knee extension naL4 foot dorsiflexionL5 toe movementS1 plantar flexion of the footS2-5 organs of the pelvis and perineum including bladder and bowel and genitals maThese muscles are listed in detail in the following table. rA©D27 © A. L. Neill
  30. 30. The A to Z of Skeletal Muscles Muscle innervation at the SC level SC level Muscle Location ill C1 Longus Capitus Neck Olquuis Capitus Superior Neck - head Rectus Capitus Anterior Neck - head Ne Rectus Capitus Major Neck - head Rectus Capitus Minor Neck - head Semispinalis Capitus Neck - head Trapezius Back C2 Longus Capitus Neck Longus Colli Neck - head Rectus Capitus Anterior Neck - head Semispinalis Capitus Neck - head C3 da Sternocleidomastoid Trapezius Levator Scapulae Longus Capitus Longus Colli Neck - head Back Neck - shoulder Neck Neck - head Semispinalis Capitus Neck - head na Rhomboideus Major Back - shoulder Rhomboideus Minor Back - shoulder Sternocleidomastoid Neck - head Trapezius Back C4 Iliocostalis Cervicis Neck - chest ma Levator Scapulae Neck - shoulder Longus Capitus Neck Longus Colli Neck - head Rhomboideus Major Back - shoulder Rhomboideus Minor Back - shoulder Sternocleidomastoid Neck - head Trapezius Back C5 Brachialis Arm rA Brachioradialis Arm Biceps Brachii Arm Deltoid Shoulder - arm Iliocostalis Cervicis Neck - chest Infraspinatus Neck - shoulder Levator Scapulae Neck - shoulder Longus Capitus Neck Longus Colli Neck - head©D Pectoralis Major Chest - arm Rhomboideus Major Back - shoulder Rhomboideus Minor Back - shoulder Scalenus Ant. Medial &Post. Neck Semispinalis Capitus Neck - head Semispinalis Cervicus Neck Serratus Anterior Chest Sternocleidomastoid Neck - head Subscapularis Shoulder Supraspinatus Shoulder© A. L. Neill 28
  31. 31. The A to Z of Skeletal Muscles Teres Major Arm - back Teres Minor Arm - back Trapezius Back ill C6 Abductor Pollicis Longus Hand - thumb Brachialis Arm Brachioradialis Arm Biceps Brachii Arm Ne Coracobrachialis Arm - elbow Deltoid Shoulder - arm Extensor Carpi Radialis Brevis Forearm - wrist Extensor Carpi Radialis Longus Forearm - wrist Extensor Carpi Ulnaris forearm - wrist Extensor Digitorum Hand - fingers Extensor Digiti Minimi Hand - little finger Extensor Indicis Hand - index finger Extensor Pollicis Brevis Hand - thumb da Extensor Pollicis Longus Flexor Carpi Radialis Iliocostalis Cervicis Infraspinatus Latissimus Dorsi Hand - thumb Wrist Neck - chest Neck - shoulder Back - arm Longus Colli Neck - head na Pectoralis Major Chest - arm Pronator Teres Forearm - wrist Scalenus Anterior Neck - head Scalenus Medial Neck - head Scalenus Posterior Neck - head Semispinalis Capitus Neck - head Semispinalis Cervicus Neck ma Serratus Anterior Chest - arm Subscapularis Scapula - shoulder Supinator Forearm - wrist Supraspinatus Neck -shoulder Teres Major Arm - chest Trapezius Back C7 Abductor Pollicis Longus Hand - thumb rA Anconeus Elbow - Arm - Forearm Brachialis Arm Brachioradialis Arm Coracobrachialis Arm - elbow Extensor Carpi Radialis Brevis Forearm - wrist Extensor Carpi Radialis Longus Forearm - wrist Extensor Carpi Ulnaris forearm - wrist Extensor Digitorum Hand - fingers©D Extensor Digiti Minimi Hand - little finger Extensor Indicis Hand - index finger Extensor Pollicis Brevis Hand - thumb Extensor Pollicis Longus Hand - thumb Flexor Carpi Radialis Wrist Flexor Digitorum Hand - fingers Iliocostalis Cervicis Neck - chest Infraspinatus Neck - shoulder Latissimus Dorsi Back - arm Longus Colli Head - neck29 © A. L. Neill
  32. 32. The A to Z of Skeletal Muscles Pectoralis Major Chest - arm Pronator Teres Forearm - wrist Scalenus Anterior Neck - head ill Semispinalis Cervicus Neck Serratus Anterior Chest - arm Subscapularis Scapula - shoulder Supinator Forearm - wrist Supraspinatus Neck - shoulder Ne Teres Major Arm - chest Trapezius Back Triceps Brachii Arm - elbow C8 Abductor Digiti Minimi Hand - little finger Abductor Pollicus Brevis Hand - thumb Abductor pollicus Longus Hand - thumb Adductor Pollicus Hand - thumb Anconeus Elbow da Dorsal Interossei Extensor Carpi Ulnaris Extensor Digitorum Extensor Digiti Minimi Extensor Indicis Hand - fingers Wrist Hand - fingers Hand - little finger Hand - index finger Extensor Pollicis Longus Hand - thumb na Flexor Carpi Ulnaris Wrist Flexor Pollicus Brevis Hand - thumb Flexor Pollicus Longus Hand - thumb Iliocostalis Cervicus +Thoracis Lumbricals Hand - fingers Opponens Pollicis Hand - thumb Palmar Interossei Hand - fingers ma Pectoralis Major Thorax - chest Pronator Quadratus Hand T1 Abductor Digiti Minimi Hand - little finger Abductor Pollicus Brevis Hand - thumb Adductor Pollicus Hand - thumb Dorsal Interossei Hand - fingers Flexor Carpi Ulnaris Wrist rA Flexor Ddigitorum Profundus Hand - fingers Flexor Digitorum Superficialis Hand - fingers Flexor Pollicus Brevis Hand - thumb Flexor Pollicus Longus Hand - thumb Lumbricals Hand - fingers Opponens Digiti minimi Hand - little finger Opponens Pollicis Hand - thumb Palmar Interossei Hand - fingers©D Pectoralis Major Thorax - chest Pronator Quadratus Hand L2 Adductor Brevis Hip - thigh Adductor Longus Hip - thigh Adductor Magnus Hip - thigh Gracilis Hip - thigh Iliacus Hip - thigh Pectineus Hip Rectus Femoris Hip - thigh - knee© A. L. Neill 30
  33. 33. The A to Z of Skeletal Muscles Sartorius Hip - thigh - knee Vastus Intermedius Vastus Lateralis Hip - thigh - knee ill Vastus Medialis Hip - thigh - knee L3 Adductor Brevis Hip - thigh Adductor Longus Hip - thigh Adductor Magnus Hip - thigh Ne Gracilis Hip - thigh IIiacus Hip - thigh Pectineus Hip Rectus Femoris Hip - thigh - knee Sartorius Hip - thigh - knee Vastus Intermedius Vastus Lateralis Hip - thigh - knee Vastus Medialis Hip - thigh - knee L4 Adductor Brevis Adductor Longus Adductor Magnus da Extensor digitorum Brevis Extensor Digitorum Longus Hip - thigh Hip - thigh Hip - thigh Foot - toes Foot - toes Extensor Hallucis Longus Foot - big toe na Gemellus Inferior Hip Gluteus Medius Hip Gluteus Minimus Hip Gracilis Hip - thigh Iliacus Hip - thigh Obturator Externus Hip - pelvis Pectineus Hip ma Peroneus Brevis Leg - ankle Peroneus Longus Leg - ankle Popliteal Knee Quadratus Femoris Hip - thigh - knee Rectus Femoris Hip - thigh - knee Tibialis Anterior Leg - ankle Vastus Intermedius Hip - thigh - knee Vastus Lateralis Hip - thigh - knee rA Vastus Medialis Hip - thigh - knee L5 Biceps Femoris Hip - thigh Extensor Digitorum Brevis Foot - toes Extensor Digitorum Longus Foot -toes Extensor Hallucis Longus Foot - big toe Flexor Digitorum Brevis Foot - toes Flexor Digitorum Longus Foot - toes©D Flexor Hallucis Longus Foot - big toe Gemellus Inferior Hip Gemellus Superior Hip Gluteus Maximus Hip Gluteus Medius Hip Gluteus Minimus Hip Lumbrical (first) Toe Obturator Externus Hip - pelvis Oburator Internus Hip - pelvis Pectineus Hip31 © A. L. Neill
  34. 34. The A to Z of Skeletal Muscles Peroneus Brevis Leg - ankle Peroneus Longus Leg - ankle Popliteal Knee ill Quadratus Femoris Hip - thigh - knee Semimembranous Hip - thigh - knee Semitendinous Hip - thigh - knee Tensor fascia Lata Hip - leg Tibialis Anterior Leg - ankle Ne Tibialis Posterior Leg - ankle S1 Biceps Femoris Hip - thigh S1 Extensor Digitorum Longus Foot - toes Extensor Hallucis Longus Foot - big toe Flexor Digitorum Brevis Foot - toes Flexor Digitorum Longus Foot - toes Flexor Hallucis Longus Foot - big toe Gastrocnemius Knee - leg da Gemellus Inferior Gemellus Superior Gluteus Maximus Gluteus Medius Gluteus Minimus Hip Hip Hip Hip Hip Lumbrical (first) Toe na Obturator Externus Hip - pelvis Oburator Internus Hip - pelvis Pectineus Hip Peroneus Brevis Leg - ankle Peroneus Longus Leg - ankle Piriformis Hip Quadratus Femoris Hip - thigh - knee ma Semimembranous Hip - thigh - knee Semitendinous Hip - thigh - knee Tensor fascia Lata Hip - leg Tibialis Anterior Leg - ankle Tibialis Posterior Leg - ankle S2 Biceps Femoris Hip - thigh Flexor Hallucis Longus Foot - big toe rA Gastrocnemius Knee - leg Gemellus Superior Hip Gluteus Maximus Hip Lumbricals (2-4) Toes Oburator Internus Hip - pelvis Piriformis Hip Semimembranous Hip - thigh - knee Semitendinous Hip - thigh - knee©D Soleus Foot - toes S3 Lumbricals (2-4) Toes© A. L. Neill 32
  35. 35. The A to Z of Skeletal Muscles Segmental Motor Diagram ill Head, upper neck and face supplied by CNs Ne C1 neck C2 infrahyoid C3 C4 upper limbs C5 shoulder C6 Biceps C7 C8 T1 T2 SPS da Triceps T3 Transverse thoracis na T4 T5 Intercostals T6 ma T7 T8 Abdominal obliques T9 SPI rA T10 T11 Hip flexion T12 L1 QL L2 L3 L4 L5©D S1 S2 Pelvis Lower limbs S3 S4 Perineal muscles S533 © A. L. Neill
  36. 36. The A to Z of Skeletal Muscles ill Ne na da ma rA©D© A. L. Neill 34
  37. 37. The A to Z of Skeletal MusclesSummaries of Skeletal Muscle Groups illMuscles of the armMuscles of the arm and shoulder Ne DeltoidRotator Cuff muscles Subscapularis, Supraspinatus, Infraspinatus, Teres Major & MinorNS from the BP – C5-7BS from the axillary artery & branchesExternal Rotators = Lateral Rotators Infraspinatus Teres Minor na da ma rAInternal Rotators = External Rotators Latissimus Dorsi Teres Minor©D35 © A. L. Neill
  38. 38. The A to Z of Skeletal MusclesMuscles connecting the arm with the VC Levator Scapulae ill Rhomboids Major & Minor Trapezius Latissimus DorsiNS segmental (C2-T12) NeBS from dorsal branches of the aortaMuscles connecting the arm with the chest wall Pectoralis Major & Minor Serratus Anterior Subclaviussegmental NS and BS from the axillary and long thoracic daMuscles in the anterior compartment of the arm - flexors Biceps Brachii Coracobrachialis Brachialis naNS musculocutaneous (C5-6)BS brachialMuscles in the posterior compartment - extensors Triceps Brachii maNS radial (C7-8)BS profunda brachii and branches rA©D© A. L. Neill 36
  39. 39. The A to Z of Skeletal MusclesMuscles of the forearm illanterior superficial Pronator Teres Palmaris Longus Flexor Carpi Radialis Ne Flexor Carpi Ulnaris intermediate Flexor Digitorum Superficialis deep Flexor Pollicis Longus Flexor Digitorum Profundus Pronator Quadratusposterior superficial daNS median and ulnar Ns - BS radial branches Extensor Digitorum na Extensor Digiti Minimi Extensor Carpi Ulnaris Anconeus deep Supinator Abductor Pollicis Longus ma Extensor Pollicis Longus & Brevis Extensor IndicisNS radial (C7-C8)BS radial and interosseous branches rA©D37 © A. L. Neill
  40. 40. The A to Z of Skeletal MusclesIntrinsic muscles of the hand illTHENAR EMINENCE (Side of the thumb)Muscles: Abductor Pollicus Brevis Flexor Pollicus Brevis Ne Opponens PollicusNS: median, C8BS: median, medial of Superfical and Deep Palmer anastomosesHYPOTHENAR EMINENCE (Side of the little finger)Muscles: Abductor Digiti Minimi Flexor Digiti MinimiNS: ulnar, T1 da Oppons Digiti MinimiBS: ulnar, lateral of Superfical and Deep Palmer anastomoses naOTHERMuscles: Adductor Pollicus Lumbricals (4) Interossei (7-8) Palmar and Dorsal maBS: ulnar and radial, palmar anastomoses and digital branches rA©D© A. L. Neill 38
  41. 41. The A to Z of Skeletal MusclesMuscles of the Hip and Buttocks (Gluteal region) illGluteus Maximus, Medius, MinimusLateral – External Rotators1 Obturator Externus Ne2 Obturator Internus3 Gemellus Inferior4 Quadratus Femoris5 Gemellus Superior6 PiriformisMedial – Internal Rotators7 Gluteus Minimus8 Tensor Fascia Lata (part of the ITB)NS local L4-S2BS superior gluteal na da 6 ma 5 1 4 rA 2 7 8©D39 © A. L. Neill
  42. 42. The A to Z of Skeletal Muscles Muscles of the gluteal region ill Muscles: Gluteus Maximus Medius and Minimus Piriformis Superior and Inferior Gemellus Ne Obturator Internus Quadratus Femoris NS: local, L4-S2 BS: superior gluteal Muscles and muscle layers of the chest and abdomen da superficial Pectoralis Major & Minor Serratus Anterior & Posterior Rectus Abdominus na middle External & Internal Intercostals External & Internal Obliques deep Innermost Intercostals ma Levator Costi Longus & Brevis Tranversus Thoracics Transverses Abdominus Quadratus Lumborum NS segmental (C3-L2) BS from C3-L2 rA©D© A. L. Neill 40
  43. 43. The A to Z of Skeletal MusclesMuscles of the Hip and Thigh illanterior compartment muscles - hip flexors / knee extensors Sartorius Iliopsoas Pectineus Ne Quadriceps Femoris = Vastus Intermedius + V. Lateralis V. Medialis + Rectoris Femoris (deep)NS femoral N (L2-5)BS femoral daposterior compartment muscles - hip extensors /knee flexors Hamstrings = Semimembranous + na Semitendinous + Biceps Femoris Adductor MagnusNS sciatic N (L2-S2)BS profunda femoris mamedial compartment muscles - hip adductors Gracilis Adductor Magnus, Longus, Brevis rA Obturator Externus PectineusNS obturator N (L2-4)BS obturator, profunda femoris©Dlateral compartment - abductor (not really a compartment) Tensor Fascia Lata - part of the Iliotibial tractNS superior gluteal (L4-S1)BS superior gluteal, lateral femoral circumflex41 © A. L. Neill
  44. 44. The A to Z of Skeletal MusclesMuscles of the leg illanterior compartment muscles - dorsi-flexors of theankle, extensors of the toes Extensor Digitorum Longus Extensor Hallicus Longus Ne Peroneus Tertius Tibialis AnteriorNS deep peroneal N (L5-S1)BS anterior tibial na dalateral compartment muscles - evertors Peroneus Brevis. LongusNS superficial peroneal N (S1-2)BS peroneal ma rAposterior compartment muscles - plantar-flexorssuperficial Gastrocnemius, Plantaris, Soleusdeep Extensor Digitorum Longus©D Flexor Hallicus Longus, Popliteus Tibialis PosteriorNS tibial N (L4-S3)BS posterior tibial© A. L. Neill 42
  45. 45. The A to Z of Skeletal MusclesIntrinsic muscles of the sole of the foot illDorsal surface of the foot - dorsi-flexors Extensor Digitorum Brevis Extensor Hallicus Brevis and Dorsal Interossei (intrinsic muscles of Ne the foot) and the tendons of the Longus Extensors cross over this surface (not shown).NS deep peroneal N (S1-2)BS dorsalis pedis na daPlantar surfacesuperficial layer - closest to the surface of the sole of the foot Abductor Hallicus Flexor Digitorum Brevis Abductor Digiti Minimi ma rA©D43 © A. L. Neill
  46. 46. The A to Z of Skeletal Musclessecond layer ill Quadratus Plantae Lumbricals and tendons of the Flexors of the toes and big toe Nethird layer na Adductor Hallicus Flexor Digiti Minimi da Flexor Hallicus Brevisfourth and deepest layer of the sole - closet to the bones Interossei Tendons of Peroneus Longus and Tibialis PosteriorNS lateral plantar (S1-3) maBS lateral plantar rA©D© A. L. Neill 44
  47. 47. The A to Z of Skeletal MusclesMuscles and muscle layers of the Back and Neck illNECK - has 2 major groups of muscles1 those concerned with the neck movement i.e. movement of the cervical spine and head; Ne2 those concerned with the anterior neck structures.These muscles are dealt with in the laryngeal, pharyngeal and other relatedstructures.Other muscles are concerned with the anterior regions of the head and arementioned here.deep posterior - suboccipital muscles - extensors (see the next pagestabilizers daincluded with the back muscles) / hyperextensors / rotators and Rectus Capitus Posterior - Major and Minor Obliquuis Capitus muscles Cervical and Cephalic / Capitus regions of the muscles of the VC naNS segmental - dorsal rami of the related SNsBS dorsal branches of the carotidsdeep anterior - prevertebral Aflexors, rotators and stabilizers ma Rectus Capitus Anterior and Lateral Longus Colli and CapitusNS segmental - ventral rami of related SNsBS branches of carotids and other local vessels rAanterior - flexors, rotators B Scalenii musclesNS segmental anterior branches of the ventral ramiBS superficial cervical©D45 © A. L. Neill
  48. 48. The A to Z of Skeletal Muscles ill A Ne na da ma B rA©D© A. L. Neill 46
  49. 49. The A to Z of Skeletal MusclesBACK - has 2 major groups of muscles ill1 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.2 those which use the VC as an immoveable post and move structures Ne around the back extrinsic concerned with the anterior neck structures.EXTRINSICmuscles which move the shoulder and arm Trapezius, Latissimus Dorsi, Rhomboids Levator Scapulaemuscles which move the rib cage da Serratus Posterior inferior and superiorNS segmental - ventral rami of related SNsBS branches of carotids and other local vesselsINTRINSIC namost superficialErector Spinae - ES divided into a number of muscle groups with regionaldistinctionsmedial lateralSpinalis Iliocostalis Longissimus ma Iliocostalis - Lumborum, Thoracis, Cervicus Longissimus - Thoracis, Cervicus, Capitus Spinalis - Thoracis, Cervicus, CapitusO & I listed individually in the text as a group rAO along the VC, Sacrum and RibsI into the VC and RibsA listed individuallyA as a group the ES extends and rotates the VCNS - segmental spinal roots generally the dorsal rami but may alos have innervation from the dorsal branches of the ventral rami branches (C1- L5) - cervical and capitus regions act upon the neck©DBS - segmental dorsal branches of the descending aorta, lumbar and sacral arteriesT - to stand up from touching toes w/o help - from upright position bend to one side and the other w/o help47 © A. L. Neill
  50. 50. The A to Z of Skeletal Muscles ill Ne na da ma rA©D© A. L. Neill 48
  51. 51. The A to Z of Skeletal MusclesThe summary below is brief and only an overview of these muscles forcompleteness of this muscle book. They are discussed in individualdetail in the A to Z of the Pelvis and Perineum and the A to Z of Surface illAnatomy.Muscles of the Perineum Ne(only female anatomy shown) 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 da 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 na these muscles overlie each other with the perineal diaphragm in b/n Superficialis - inferior to Profundus hence closer to the skinNS pudendal (S2-4) maBS 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 rA sphincter hence circular muscle inserting all around natural position - constricted rather than relaxedA muscles of this region act to support the pelvic contents and the perineumand are intimately related so that damage to any of this basin of tissue willhave profound effects on the functional capacities of the others.©DNS pudendal and Ns from SP (S2-4)BS internal iliacs49 © A. L. Neill
  52. 52. The A to Z of Skeletal Muscles ill Ne na da ma rA©D© A. L. Neill 50
  53. 53. The A to Z of Skeletal MusclesThe summaries below are brief and only an overview of these musclesfor completeness of this muscle book. They are discussed in individualdetail in the A to Z of the Head and Neck. illMuscles of the Eye - note all 6 of these muscles act “in concert” ineye movement and depend upon the fixation and focus of the eye NeExtrinsicMuscles responsible for movement of the upper eyelid Levator Palpebrae Superioris NS occulomotor N (CNIII) BS supraorbital, branches of ophthalmic daMuscles responsible for movement of the eyeball Recti muscles - Inferior /Superior, Medial/Lateral. These muscles are straight and are responsible for onemovement up/down, in/out Oblique muscles - Inferior, Superior na These muscles are attached via a trochlea or pulley and movements therefore vary on eye position and are diagonal up and out/ down and inAll are attached to the scleral surface, the Recti via the optic canal onthe common annular tendon, and the Obliques via bones in the optic macavityNS oculomotor N (CNIII) - except Lateral Rectus - abducent N (CNVI) andSuperior Oblique - trochlea N (CNIV)BS ophthalmic and branches of internal carotid rAIntrinsicThese muscles are responsible for moving structures within the eyeballand are not shown.NS oculomotor N (CNIII) also branches from the autonomic NSBS ophthalmic and branches of internal carotid©DCiliaris, Dilator Pupillae, Sphincter Pupillae51 © A. L. Neill
  54. 54. The A to Z of Skeletal Muscles ill Ne na da ma rA©D© A. L. Neill 52
  55. 55. The A to Z of Skeletal MusclesMuscles of the Face illExpressionBuccinator - see individual listingCorrugator Supercili - see individual listingDepressor Anguli Oris, see individual listing NeDepressor Labii Inferioris, see individual listingDepressor Septi see individual listingFrontalis (of Occipitofrontalis), see individual listingIncisivus Labii Superioris & InferiorisThese muscles insert into the other muscles of the mouth and assistOrbicularis Oris in protruding the lipsLevator Anguli Oris (Caninus),Levator Labii SuperiorisLevator Labii Superioris alaeque nasi daThese muscles evert the upper lips medially and laterally assisting OrbicularisOris and the Zygomaticus musclesMentalis see individual listing naNasalis (compressor & dilator)These muscles change the aperature of the nares (nostrils) assistingDepressor SeptiOrbicularis Oculi see individual listingOrbicularis Oris see individual listingPlatysma see individual listing maProcerusThis muscle depresses the medial end of the eyebrow assisting bothOrbicularis Oculi and Corrugator SuperciliRisorius see individual listingZygomaticus Major & Minor see individual listing rANS facial N (CNVII)BS facialThese muscles are often involved in cosmetic surgery and their function maybe compromised by incisions at the level of the deep fascia.Mastication©DMasseter, see individual listingPterygoids Lateral, Medial see individual listingTemporalis see individual listingAll are attached to the Mandible - Jaw bone and part of theSplanchnocraniumNS trigeminal N (CNV)BS trigeminal and facial branches53 © A. L. Neill
  56. 56. The A to Z of Skeletal Muscles ill Ne na da ma rA©D© A. L. Neill 54
  57. 57. The A to Z of Skeletal MusclesMuscles of the Thyroid & Hyoid ill - superficial anterior neck muscles - muscles of the Anterior Triangle - strap muscles NeDigastricus - see individual muscle listingGeniohyoidMylohyoidThese muscles elevate and position the Hyoid and the floor of the mouth tofacilitate swallowing and occlusion of the LarynxNS hypoglossal and C1 of ansa cervicalis BS facial branchesOmohyoidSternohyoidSternothyoid daThese muscles depress the Hyoid after swallowing naNS ansa cervicalsis C1-3 BS thyroid vesselsStylohyoidThyrohyoid maThese muscles are involved in support of swallowing - Thyrohyoid both lowersand elevates the HyoidNS ansa cervicalis C1-3 BS facial and thyroid vesselsAs a group, these muscles define the neck line and shape, are involved inswallowing and sound production may be tightened in cosmetic surgery - theymay attach to the Hyoid, Sternum and other bones in the region as a rA“through” bones - i.e. they have fascial slings to support them and separatethem into 2 muscle bellies.©D55 © A. L. Neill
  58. 58. The A to Z of Skeletal Muscles ill Ne na da ma rA©D© A. L. Neill 56
  59. 59. The A to Z of Skeletal MusclesMuscles of the Larynx and Pharynx illSalpingopharyngeus - attaches to the inferior of the auditory tube andblends with Palatopharyngeus to raise the pharyngeal wall close off theauditory tube for swallowing NePalatopharyngeus - attaches to the Thyroid cartilages and the Palate to bringthe pharynx forward allowing food to leave the mouth and enter the pharynxStylopharyngeaus - attaches to the styloid process and the constrictors toelevate and dilate the pharynx in the early stages of swallowingPharygneal Constrictors - superior, middle, inferior - attach to the Medial daPterygoid plate, Hyoid and Thyroid cartilages and blend in with each other andthe posterior root of the tongue in order to commence swallowing and theresultant peristaltic movement -NS vagus (CNX) and branches of ansa cervicalis (C1-3) naBS maxillary, facialNote in CVAs - strokes these muscles under voluntary control and are involvedin the early stages of swallowing - so may be affected greatly limiting theperson’s capacity to swallow maCricothyroid - attached to the laryngeal cartilagesArytenoids muscles attached to the arytenoids cartilages at the back of thevocal cords responsible for altering the shape and angle of these cartilagesCricoarytenoids - posterior and lateral, Thyroarytenoid, Transversearytenoids,Vocalis - also attached to the arytenoids cartilages for voice regulation. rANS for most of these muscles comes from the vagus (CNX)BS from the thyroid vessels and branches of the carotids©D57 © A. L. Neill
  60. 60. The A to Z of Skeletal Muscles ill Ne na da ma rA©D© A. L. Neill 58
  61. 61. The A to Z of Skeletal MusclesMuscles of the Soft Palate illLevator Veli Palatini - attaches to the inferior surface of the Temporal boneto lift the soft palate and separate the naso and oropharynxMuscularis Uvulae - attaches to the posterior spine of the Palatine bone and Nethe Uvula to elevate itPalatoglossus - attaches to the oral surface of the Palate to the side of thetongue to allow the tongue to rise and shut off the mouth from the oropharynxTensor Veli Palatini - attaches to the side of the auditory tube and medial ofthe spine of the Sphenoid bone to the hard palate to close both the naso andoropharynx daNS mainly from glossopharyngeal N (CN IX)BS facial palatine vessels and branchesIt is changes in these muscles which may result in snoring and sleep naapnea. ma rA©D59 © A. L. Neill
  62. 62. The A to Z of Skeletal MusclesMuscles of the Tongue illExtrinsicGenioglossus - attaches to the Hyoid, Pharyngeal constrictors, Hypoglossusand intrinsic Lingualis muscles to protrude tongue (poke out the tongue)depress the centre and raise the sides (make a tunnel with the tongue) NeHyoglossus - attaches to the front and horns of the Hyoid, side of the tongueand intrinsic Lingualis muscles in order to depress the tongue (as in sayAHHHHH…)Styloglossus - attaches to the styloid process, and blends with theHypoglossus, StylohyoidIntrinsic daLinguali muscles - superior, inferior, transverse and verticalattach w/in the tongue to change its shape for speech, in mastication andswallowing naNS lingual, sublingual and hypoglossal (CNXII) NsBS lingual, sublingual and external carotid ma rA©D© A. L. Neill 60
  63. 63. The A to Z of Skeletal MusclesExamination of Skeletal Muscles - major groups illnote detailed examinations of individual muscles are listed in the A to Z of Sensory andMuscles testing as well as general testing listed after each muscle in the text. ROM anda selection of strength tests of major movements are included hereHx - questions for individual joint examination Ne1 functional limitation2 SS -limited to one or more joints3 onset - acute - related to a specific incident - chronic - slow progressive increase of pain or reduced ROM4 description of the causative agent if known e.g. accident5 any prior MSS history of that joint or others6 Systemic problemsEx - for participation in sport/training activities MSSpositions for specific testing dafor this examination unless otherwise indicated the patient standing - facing the clinicianin the anatomical position - included are several tests with the patient in alternativeCERVICAL SPINE / NECK - ROM tests the following groups of musclesScalenes/Colles/Trapezius upper fibres/Cervicis regions of ES and deep muscles of theVC/Sternocleidomastoid napatient looks at the roof ± R extensionpatient looks at the floor ± R flexionpatient looks over each shoulder ± R horizontal rotationhead bends towards the shoulder - sideways ± R(shoulders kept still) lateral flexion maSHOULDER (SCAPULA) - ROM tests the following groups of musclesLevator Scapulae/Rhomboids/Serratus Anterior/Spinati muscles/Trapezius/Deltoidobserve symmetry of shoulder particularly the Acromioclavicular jtshrug shoulders ± R elevationdrop shoulders depressionstraighten shoulders - trying to meet shoulder blades lateral rotationcontract shoulders - withdrawing chest medial rotationabduct shoulders to 90o (flexed arm) ± R abduction rAStrength tests - Shoulder©D61 © A. L. Neill

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