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UNIT TWO Study Guide p. 15 Before we talk about individual muscles, we need to understand movement. If you raise your shoulders, what movement is it? What’s the movement of raising your arm to the side verses the front? Start in Anatomical position. Feet on the floor, palms up. FLEXION: reduces the angle of the joint from the anatomical position. Flex elbow EXTENSION: movement that returns you to anatomical position. Extend elbow. All these terms refer to either a body part or a joint. Can flex elbow or flex joint. HYPEREXTENSION: extension beyond anatomical position; wrist, neck. Some terms relate only to certain areas, such as the ankle: 1 DORSIFLEXTION: lift up toes PLANTARFLEXION: move toes down INVERSION: when sole of foot points inward EVERSION: sole of foot points outward. ABDUCTION: move body part away from midline; arm, fingers, thumb ADDUCTION: bring back to midline; arms, fingers, thumb ROTATION: pivot on an axis; shake head “no”; can rotate head and shoulder CIRCUMDUCTION: to draw a circle with body part; shoulder, head PRONATION (to lie prone is on stomach). Turn hands downward. SUPINATION: refers to arms; want a bowl of soup, supinate PROTRACTION: to move anteriorily; shoulders, mandible RETRACTION: to move part posteriorly ELEVATION: to raise part superiorly; shoulders DEPRESSION: to lower part; open mouth. 2 p. 16 Major Surface Landmarks It’s important to know these so you can communicate and chart the location of injuries. Can’t say the laceration is 3cm from the spleen, because you can’t see the spleen. Page 16 is a partial list; the boney landmarks we already know; lateral malleolus, occipital condyle, acromium process, etc. GLABELLA: space between eyebrows BRIDGE: between eyes DORSUM OF NOSE: superior surface ALA OF NOSE: (Ala = wings) NOSTRILS PHILTRUM: ridge between nose and lip AURICLE: (PINNA): outer ear HELIX: ridge of outside of ear TRAGUS: flap on ear that covers auditory canal 3 EAR LOBE THYROID CARTILAGE (Adam’s apple) JUGULAR NOTCH: ridge between two clavicles above manubrium NIPPLE AREOLA: pigmented area around nipple COSTAL MARGIN: edge of ribcage UMBILICUS (NAVAL): belly button INGUINAL REGION: the crease between abdomen and thigh; ant sup iliac crest pub symph GLUTEAL CLEFT (NATAL CLEFT): butt crack PERINEUM: between genitals and anus 4 p. 17 MUSCLES SECTION There are hundreds of muscles, but we are only going to learn about 75. Why these 75 muscles? Three reasons: 1. The most important ones (a physical therapist will need to know all muscles) 2. The most superficial and obvious ones, easy to dissect 3. The most interesting ones p. 18 Need to know origin, insertion, and action. Will be on test. Why dissect cats? Seeing a dissected cadaver is a waste of time. You learn during the dissection. It takes a year to properly dissect a human. Cat anatomy is a lot like a human’s. The cats we dissect are stray cats that were picked up by the pound and put to sleep. There are 3 million stray dogs and cats put to sleep a year. A few 5 thousand are bought by companies that inject them with latex and sell them to schools. No cats died just for this class. For every muscle, need to know it in the human. Use these plastic models, and use photographs of body builders (they use steroids which cause hypertrophy of the muscles). Problems with steroid use: 1. Cause enlargement of the heart, so it doesn’t work as efficiently 2. Increases risk of cancer 3. Injecting testosterone, so body stops making its own testosterone, genitals shrink 6 MUSCLES OF FACIAL EXPRESSION These are cutaneous muscles; their insertion in the skin, so they move the skin; smile, etc. We will only learn six (there are dozens) 1. FRONTALIS: raise eyebrows. Wrinkle forehead. Origin is tendonous sheath over scalp. a. Galea Aponerosis (aponeurosis = thick flap). The scalp is not attached to the skull. You can take your hands and move it back and forth (try it now). The scalp is highly vascularized; if you cut it, it bleeds profusely. If you cut this muscle, the entire scalp peels away. In a car accident, a person can cut his entire forehead on the dashboard, and the scalp will peel away. During brain surgery, you just need to make a small incision in the hairline, and you can lift the scalp to expose the bone to cut. 7 2. ORBICULARIS OCULI: circular muscle around the eyes. When it contracts, eye closes; blinks 3. ZYGOMATICUS: muscle for smiling. It runs from the zygomatic arch to the corner of the mouth. Some muscles are not under direct voluntary control. If you fake a smile, the corners of the mouth go back. When you mean it, the corners come up. 4. OBICULARIS ORIS: circular muscle around mouth; purse lips, 5. BUCCINATOR: in cheek; sucks in cheek; important in chewing to prevent food from going into the cheek pockets. 6. PLATYSMA: this is not on the plastic model because it’s so big, it would cover up too many other things. It goes from the chest up the anterior half of neck, and inserts into the skin along the jaw. Try to clench your teeth and push your neck out, and you can see it. Its function is to make you look scary by having a bigger neck. 8 Muscles of Facial Expression frontalis (H) o(origin): galea aponeurotica i(insertion): skin of eyebrows a(action): raises eyebrows; wrinkles forehead orbicularis oculi (H) o: frontal and maxillary bones i: eyelid a: closing eye; squinting zygomaticus (H) o: zygomatic bone i: corner of mouth a: raises corner of mouth in smiling 9 orbicularis oris (H) o, i: encircles mouth a: closes lips; protrudes lips buccinator (H) o, i: maxilla and mandible a: draws cheeks in, as in sucking platysma (H) o: fascia of chest i: lower margin of mandible a: tenses skin of neck 10 MUSCLES OF MASTICATION 1. MASSETER: put hands on your cheek and clench teeth to feel it. 2. TEMPORALIS: put hands on parietal bone and clench teeth to feel it. Both of these muscles elevate the jaw. Why do you need two muscle to do one job? They do different things. Masseter operates 2nd Class lever system Temporalis operates 3rd Class lever system. What’s the advantage of a 2nd class lever? More force. What’s the advantage of a 3rd class lever? More distance. When the mouth is open all the way, the initial movement to close it is by the Temporalis muscle. It doesn’t need a lot of force. Once it’s mostly closed, the masseter can take over. They are synergists. 11 If you decide the medical field is not for you, you can become a lion tamer now, because you know how lion tamers get away with sticking their head in a lion’s mouth… when the mouth is opened wide, it only takes a little force to keep it open. TMJ: tempomandibular joint (show on skull skeleton) 12 This is both a hinged joint and a gliding joint. Look at the condyles on the temporal bone. They are shallow. That means they can become dislocated slightly = TMJ Syndrome. This can lead to problems that are hard to find the cause of, like pain in the neck, headaches, etc. Dentists are supposed to check for this at every single visit. They put their hand on the TMJ and have you open and close your mouth to check for dislocation. Another problem is total dislocation of the jaw, caused from opening the mouth all the way. When would someone open their mouth all they way? In a yawn. Often occurs when drunk, because the muscle control becomes poor. Saturday night they wind up in the emergency room, unable to close their mouth, in a lot of pain, with their buddies laughing at them. The nurse just puts her thumbs on the molars and pushes down really hard, and the jaw should snap back into place. 13 Muscles of Mastication masseter (H) o: zygomatic arch i: ramus of mandible a: primary elevator of mandible temporalis (H) o: temporal and parietal bones i: coronoid process of mandible a: elevates mandible 14 MUSCLES OF POSTERIOR NECK p.18 1. SPLENIUS CAPITIS: pulls and rotates the head 2. SEMISPINALIS CAPITUS: contraction hyperextends the neck Muscles of Posterior Neck splenius capitis (H) o: spinous processes of upper thoracic vertebrae i: mastoid process of temporal bone a: extension and rotation of head semispinalis capitis (H) 15 o: lower cervical vertebrae i: occipital bone a: extends head MUSCLES OF THE ANTERIOR NECK, p.18 These are a good place to start; although they are small, they are easy to see and id, and their name tells you about them. The majority of these are originating or inserting on the hyoid bone. This is a very important bone. There are more muscles on that bone than any other bone in the body: 18 muscles. Why so many? You need to understand the function of the hyoid bone. It forms the base of the tongue. The tongue muscles originate on the hyoid bone. To allow the flexibility of the tongue, the tongue needs a platform from which it can elevate, depress, retract, protract, flex, extend, and tilt. Most muscles of the anterior neck move the hyoid bone. 16 p. 270 BOOK 1. DIGASTRIC muscle has two bellies. They can work together (synergistic) or separately. They are the primary depressor of the mandible. When you open your mouth, both bellies contract synergistically. When the posterior belly only contracts, the hyoid is elevated, which is needed to swallow. Try to open your mouth and swallow. Can you? No. When your mouth is open, both of the muscles are contracting. 17 2. MYLOHYOID originates from the mandible, and meets at the midline. When it contracts, it elevates the floor of the mouth. 3. STERNOHYOID originates from the sternum and inserts on the hyoid. It runs from here to here (demonstrate on self). When this muscle contracts, what’s going to move, the sternum? No. The hyoid depresses. 18 4. THYROHYOID depresses hyoid, and tilts it a little to the side 5. STERNOTHYROID depresses or fixates the hyoid. 6. STERNOCLEIDOMASTOID: This muscle does not belong. It moves the head. It originates on the clavicle and inserts on the mastoid process. See the bulge on the side of your neck? When one side contracts, it rotates the head. When both contract, they flex the head. 19 20 Muscles of the Anterior Neck digastric (H,C) o: mastoid process of temporal bone i: lower margin of mandible (via hyoid bone) a: primary depressor of mandible; elevates hyoid during swallowing mylohyoid (H,C) o: medial surface of mandible i: midline (where the two muscles meet) and hyoid a: elevates floor of mouth stemohyoid (H,C) o: manubrium i: hyoid a: depresses hyoid 21 thyrohyoid (H,C) o: thyroid cartilage i: hyoid bone a: depresses hyoid sternothyroid (H,C) o: manubrium i: thyroid cartilage a: depresses thyroid cartilage sternocleidomastoid (H,C*) o: manubrium and medial clavicle i: mastoid process of temporal bone a: flexes and rotates head 22 MUSCLES OF THE PECTORAL GIRDLE (p.18-19) They all have their origins on the clavicle or scapula. Generally, muscles cross a joint and move the part distal to that joint. For example, if a muscle’s origin is on the scapula and inserts into the humerus, It will move the humerus. TRAPEZIUS is fairly thin, broad, and has important functions. 1. Elevates the shoulder 2. Retracts the shoulder. RHOMOIDEUS MAJOR and MINOR are like one muscle. 1. They are two of the main retractors of the scapula 2. Also are fixators of the scapula 23 SUPRAPSPINATUS, INFRASPINATUS, SUBSCAPULARIS, TERES MAJOR These four muscles are important because their tendons form the rotator cuff. They envelop the proximal end of the humerus, and hold it in place. When you are lifting a heavy weight, they keep the humerus from dislocating. A violent motion can tear the rotator cuff, however, like pitching a baseball (see tear in model). The most common thing to tear in a rotator cuff injury is the tendon of the supraspinatus. TERES MAJOR runs from the scapula to the humerus. You can feel it under your axilla as a lump. 24 PECTORALIS MAJOR is a flexor and adductor of the arm. It inserts on the INTERTRABICULAR GROOVE on the humerus. When it contracts, it pulls the arm in and up (Put hand over heart, fingers angled up to shoulder, contract). PECTORALIS MINOR is deep to Pectoralis Major. It is a protractor of the scapula. Its origin is on the ribs and inserts into the scapula. SERRATUS ANTERIOR is over the ribs. When you look in the mirror and see stripes there, those are not ribs; that is this muscle. It is another protractor of the scapula. When you are pushing something (against the wall), it gives you extra force. 25 The pectoralis minor and serratus anterior can also assist in breathing. When the scapula is fixed, it elevates the ribcage. Try this: Relax your shoulders and take a deep breath. Now put your hands on your hips, fix your shoulders and take a deep breath. Notice that breath was deeper; it expanded the ribcage more because you’re using the pectoralis minor and serratus anterior since your shoulders are fixated. DELTOID is the 1° abductor of the arm. It’s the muscle that gets injected when you get a shot in the arm, because there are no major nerves or blood vessels to hit by accident. 26 Muscles of the Pectoral Girdle trapezius (H,C) o: thoracic and cervical vertebrae and occipital bone i: spine of scapula and clavicle a: rotates scapula; retracts scapula rhomboideus major and minor (H,C*) o: upper thoracic vertebrae i: medial border of scapula a: stabilizes scapula; retracts scapula supraspinatus (H,C) o: supraspinous fossa of scapula i: greater tubercle of humerus a: stabilizes humerus (as when carIying a suitcase) 27 infraspinatus (H,C) o: infraspinous fossa of scapula i: greater tubercle of humerus a: stabilizes humerus (as when carrying a suitcase) subscapularis (H,C) o: subscapular fossa of scapula i: lesser tubercle of humerus a: rotates arm medially; stabilizes humerus (as when carrying a suitcase) teres major (H,C) o: posterior surface of scapula i: greater tubercle of humerus a: extends and adducts arm and stabilizes humerus (as when carrying a suitcase) 28 pectoralis major (H,C*) o: sternum and upper costal cartilages i: intertubercular groove of humerus a: flexes and adducts arm pectoralis minor (H) o: ribs 3, 4, and 5 i: coracoid process of scapula a: draws scapula forward and downward serratus anterior (H,C) o: ribs 1 8 i: medial border of scapula a: protracts scapula (used in pushing objects, punching) - 29 latissimus dorsi (H,C) o: lower thoracic and lumbar vertebrae i: intertubercular groove of humerus a: primary extensor of arm (used in bringing arm down in swimming) deltoid (H,C*) o: spine of scapula i: deltoid tuberosity of humerus a: primary abductor of arm rotator cuff (H) 30 MUSCLES OF THE ARM (P.20) ARM (Roll up your sleeves!) TRICEPS BRACHII is the main extensor of the arm. BICEPS BRACHII is one of the main flexors of the arm. It inserts on the RADIAL TUBEROSITY. When you pronate, the radial tuberosity moves around, so the biceps brachii is no longer an efficient flexor. Put your hand on your biceps and flex: feel the muscle contract? Now pronate your arm (elbow up and out to the side, palm down) and flex. That is the BRACHIORADIALIS, which is the main flexor of the arm. Flex against resistance and it will bulge out. That’s an important landmark. 31 Muscles of the Arm triceps brachii (H,C) o: proximal humerus; scapula i: olecranon process of ulna a: extensor of forearm biceps brachii (H,C) o: scapula i: radial tuberosity a: flexor of forearm brachioradialis (H,C) o: distal end of humerus i: styloid process of radius a: flexes forearm 32 THE HEART This is the PARIETAL PERICARDIUM and the VISCERAL PERICARDIUM. The sheep heart is different from ours on the outside, so look at the outside of the heart on the plastic models. Cut the heart in two using a CORONAL section. You’ll only see three of the four heart chambers because of the angle of the cut. Take the scalpel blade off and on properly, cut away from yourself, rinse it, put on the cover, and put it back in your kit. Remember, it’s designed to cut human flesh, so be careful! Note the VENTRICULAR SEPTUM. 33 There are two sides of the heart; right and left. The left side here is thicker because it’s up against the body. On a sheep, the right and left ventricles are the same size because blood flows evenly there. Note the LEFT ATRIUM, LEFT VENTRICLE, and the MITRAL VALVE. Note the RIGHT ATRIUM, RIGHT VENTRICLE, and the TRICUSPID VALVE. Trace the blood through the chambers and vessels. Note the CORDAE TENDONAE, which keep the valves in place. Blood comes out the AORTA, past the SEMILUNAR VALVE. When you’re done, put the heart in a baggie and put a sticker on it. 34 SLIDES ON DISPLAY Cardiac sec with intercalated discs Artery, vein, nerve Artery, vein, nerve elastic tissue Aorta elastic tissue Look at the model of the human heart and the slides. Model of human heart: some people have hearts this big (and then they die). Hypertrophy of the heart can be caused from hypertension or steroids. Know the names of vessels, including the AORTA, PULMONARY ARTERY and VEIN, AORTIC TRUNK, SUPERIOR and INFERIOR VENA CAVA. This model is nice because it shows the TRACHEA. 35 The first artery to come off the aorta is the CORONARY ARTERY, which has two main branches; the RIGHT and LEFT coronary artery, with the POSTERIOR INTERVENTRICULAR ARTERY between them. The left coronary artery branches almost immediately into the ANTERIOR INTERVENTRICULAR ARTERY and the CIRCUMFLEX ARTERY. Note the valves, chambers, chordae tendonae, and the semilunar valves. 36 There are slides of different types of blood vessels except for lymph vessels (they look like veins). There are slides of all three types of muscle: skeletal muscle, cardiac muscle, and smooth muscle can be seen in the tunica media of muscular arteries. On skeletal muscle, you can see the striations, and the intercalated discs = gap junctions. 37 Heart anterior interventricular artery (H) apex (H,S) aorta (H,S) aortic semilunar valve (S) atrial septum (H,S) circumflex artery (H) chordae tendinae (S) inferior vena cava (H) left atrium (H,S) left coronary artery (H) left ventricle (H,S) mitral valve (bicuspid valve) (H,S) papillary muscles (S) parietal pericardium (S) 38 pericardial cavity (S) posterior interventricular artery (H) pulmonary arteries (H) pulmonary semilunar valve (H,S) pulmonary trunk (H) pulmonary vein (H) right atrium (H,S) right coronary artery (H) right ventricle (H,S) superior vena cava (H,S) tricuspid valve (S) ventricular septum (H,S) visceral pericardium (S) 39 MUSCLES OF THE FOREARM (the muscles that move the wrist and hand) There are flexors on the hairy side of your forearm, and extensors on the smooth side. Flexors are bordered by the ulna medially, and the Brachial Radialis laterally. PRONATOR TERES is not a flexor or an extender; it pronates the forearm. Shake hands with someone and have them try to pronate with you resisting; feel your pronator teres bulge. Wrap your arm up with Saran Wrap and you can mark where the muscles are. The next exam, you can bring a whole set of muscles with you! 40 FLEXORS Find the Brachioradialis, and then move medially; there’s the FLEXOR CARPI RADIALIS, the flexor of the wrist on the radial side. Move more medially and there’s a small muscle, the PALMARIS LONGUS, you can only see its tendon. Clench fist and flex, and the tendon should pop out. Those who don’t have one are more evolutionarily advanced. The muscle is useless, but the tendon can be used as a graft elsewhere. It’s the smallest muscle of the forearm in the human, but the largest one in the cat…why? Cats need to walk with it, and we only need to wave. Deep to it is the FLEXOR DIGITORUM SUPERFICIALIS, which you can feel when you wiggle your fingers. There are two muscles that flex the fingers; the other one is Flexor Digitorum Profundus, which you can’t see; you just need to know there are two muscles that flex the fingers. 41 On the hairy side of your arm, next to the ulna, is the FLEXOR CARPI ULNARIS; which flexes the hand. Then there is EXTENSOR CARPI ULNARIS, EXTENSOR DIGITORUM, and EXTENSOR CARPI RADIALIS (LONGUS AND BREVIS) Muscles of the Forearm pronator teres (H,C) o: proximal end of ulna i: middle of radius a: pronates forearm flexor carpi radialis (H,C) o: medial epicondyle of humerus i: base of metacarpals a: flexes and abducts wrist 42 palmaris longus (H,C*) o: medial epicondyle of humerus i: palm aponeurosis a: flexor of wrist flexor carpi ulnaris (H,C) o: medial epicondyle of humerus i: base of fifth metacarpal a: flexor and adductor of wrist flexor digitorum superficialis (H,C) o: medial epicondyle of humerus i: middle phalanges of fingers a: flexes fingers 43 extensor carpi radialis (longus and brevis) (H,C) o: lateral epicondyle of humerus i: base of second metacarpal a: extends and abducts wrist extensor digitorum (H,C) o: lateral epicondyle of humerus i: distal phalanges of fingers a: extends fingers extensor carpi ulnaris (H,C) o: lateral epicondyle of humerus i: base of fifth metacarpal a: extends and adducts wrist flexor retinaculum (H) 44 MUSCLES OF THE HAND (P.20) PALM (There are three groups of muscles, don’t need to know origins/insertions) THENAR MUSCLES are the flexors and adductors of the thumb. The extensors are in the forearm. HYPOTHENAR MUSCLES are the flexors and opposers of the fingers. PALMAR MUSCLES: there are 3 muscles for every digit, to abduct, adduct, and flex. In the middle of the palm is the PALMAR APONEUROSIS. It functions to protect the palm; that’s why you can hit it, and even though there are nerves there, it doesn’t hurt. 45 There is a band of connective tissue around the wrist called the FLEXOR RETINACULUM. It continues on the top of the wrist as the EXTENSOR RETINACULUM. The flexor retinaculum forms the CARPEL TUNNEL. 46 47 Inside the carpel tunnel (draw cross section of the wrist) is the flexor digitorum superficialis, profundus, median nerve, and two arteries, etc, all squeezed into a small area. With repetitive motion such as typing, the tendons become inflamed = tendonitis, and it puts pressure on the nerve and blood vessels, causing pain. What’s that called? CARPEL TUNNEL SYNDROME. One treatment is to slice the flexor retinaculum to relieve the pressure. By the way, slashing your wrist is not a good way to commit suicide. All you do is slice the tendons and the nerves, and wind up with a paralyzed wrist. 48 Muscles of the Palm thenar muscles (H) This is a group of 4 muscles that moves the thumb. hypothenar muscles (H) This is a group of 3 muscles that move the little finger. palmar muscles (H) This is 3 groups of muscles that abduct, adduct, and flex the fingers. 49 MUSCLES OF THE TRUNK AND PELVIC GIRDLE (p. 21) INTERCOSTALS (“Between the ribs”). These are what you eat when you go to Tony Romas. There are two sets: EXTERNAL and INTERNAL. You won’t see the internal. External elevates the ribs when breathing. Internal depresses the ribs. They are not very strong; they move just a little. They help a fractured rib to stay in place. ABDOMINAL MUSCLES RECTUS ABDOMINUS is one of the strongest flexors. It is separated into 4 muscles by small tendonous insertions. If there was just one big muscle, it would bulge and get in the way, so being four smaller muscles gives better range of motion. 50 Three muscles on the sides insert on the linea alba (“White line”) and inguinal ligament. EXTERNAL OBLIQUE is the outermost muscle. Its fibers run in the same direction as though you were putting your hands in your pockets. INTERNAL OBLIQUE is deeper; the fibers run upwards TRANSVERSE ABDOMINUS is the deepest; it runs transversely. 51 When you have appendicitis, the surgeon has to cut through these muscles, then has to sew them each up, whereas in open heart surgery, you just break the sternum and ribs to get right in. Ribs can heal faster than soft tissues sometimes. MUSCLES OF THE TRUNK ERECTOR SPINAE (a group of muscles) holds you erect, supporting the back. They are active all day, and can cause back pain. There are a lot of muscles here, all synergists with each other. 52 Muscles of the Trunk external intercostals (H,C) o: inferior border of each rib i: superior border of rib below a: elevates ribs internal intercostals (H) o: superior border of each rib i: inferior border of rib above a: depresses ribs external oblique (H,C) o: distal margins of lower ribs i: linea alba, inguinal ligament a: flex abdomen; compress abdomen 53 internal oblique (H,C) o: iliac crest i: linea alba; inguinal ligament a: flex abdomen; compress abdomen transverse abdominis (H,C) o: lumbar vertebrae i: linea alba; inguinal ligament a: flex abdomen; compress abdomen rectus abdominis (H,C) o: pubic symphysis i: costal cartilages a: flex abdomen; compress abdomen erector spinae (H) This is a group of muscles which run along the dorsal surfaces of the vertebrae and extends the back. 54 PELVIC GIRDLE All of the muscles here originate on the pelvis and move the thigh. SARTORIUS (“Tailor” If you’re dressed nicely, you are in sartorial splendor) originates on the anterior superior iliac spine, and inserts on the medial side of the tibia. It is on of only a few muscles that cross 2 joints and moves 2 joints. To get these two joints closer together, what movement is that? It flexes the thigh and rotates it. It was named after tailors because they used to sit cross-legged to sew. GLUTEUS MAXIMUS is one of the most important extensors of the thigh. If I life my leg in the air, I’m flexing the hip. So what motion is extension? Returning it to anatomical position. But this is a huge muscle, and returning it to the floor doesn’t require much strength. But when you walk, your full body weight is on it while your foot is on the ground. 55 GLUTEUS MEDIUS is a powerful abductor. It needs to be strong also, because when you walk, you tilt a little from side to side, and the medius needs to straighten you back up. When you get a shot in the rear, it goes into this muscle. You can’t give a shot in the gluteus maximus, because there is a nerve under there, the sciatic nerve, that is the largest nerve; stay away from that! A study showed that 50% of injections, which are supposed to be in the gluteus medius, are actually getting in the fat, so they are going to start using longer needles! 56 ADDUCTOR MAGNUS is one of the many adductors, also used to stabilize the body. There is another small adductor that has many injuries called the GRACILIS (“graceful” or thin). This is the muscle involved when you tear a groin muscle. It gets torn in athletes when they are falling to one side with the weight on one foot, and the adductors have to pull the entire body weight back to straighten out. The gracilis is the smallest, so it will tear. 57 Muscles of the Pelvic Girdle sartorius (H,C) o: anterior superior iliac spine i: medial portion of proximal tibia a: flexes and laterally rotates thigh (crosses legs) gluteus maximus (H,C) o: dorsal ilium and sacrum i: gluteal tuberosity of femur a. primary extensor of thigh when walking gluteus medius (H,C) o: lateral surface of ilium i: lateral portion of proximal femur a: abducts thigh 58 adductor magnus (H,C) o: pubis and ischial tuberosity i: medial portion of femur a: adducts thigh gracilis (H,C) o: pubis i: medial surface of proximal tibia a: adducts thigh 59 MUSCLES OF THE THIGH (p. 23) QUADRICEPS FEMORUS: A group of four muscles of the anterior thigh. 1. RECTUS FEMORUS 2. VASTUS MEDIALIS 3. VASTUS LATERALIS 4. VASTUS INTERMEDIUS All four have insertions onto the same place by way of the PATELLAR LIGAMENT into the tibial tuberosity. This is the larges group of muscles in the body. They are huge and powerful…why? Their function is to extend the knee (from bent to straight). Why need power to do that? Because they have to lift the entire body weight when the knee is bent and straightens while walking. 60 Posterior Thigh HAMSTRINGS (what you are eating when you eat a ham sandwich) 1. BICEPS FEMORIS (don’t write biceps, pects, lats, or glutes; write whole name) 2. SEMITENDONOSIS (more superficial) 3. SEMIMEMBRANOSIS (deep) These are the flexors of the knee. They also wrap around the knee to stabilize. In the cat, just know the quadriceps and hamstrings. In the human, know the individual names. TENSOR FASCIA LATAE is a small muscle that inserts into the ILIOTIBIAL BAND on the lateral aspect of the thigh. It is a synergist for the quadriceps femoris. 61 Muscles of the Thigh quadriceps femoris: rectus femoris, vastus lateralis, vastus medialis, vastus intermedius (H,C) o: different origins along the femur for each muscle i: tibial tuberosity via patellar ligament a: extends knee especially when walking hamstrings: biceps femoris, semitendinosus, semi membranosus (H,C) o: ischial tuberosity i: lateral condyle of tibia (biceps femoris) i: medial condyle of tibia (semitendinosus, semimembranosus) a: flexes knee tensor facia latae (H,C) o: anterior iliac crest i: iliotibial tract a: flexes and abducts thigh 62 MUSCLES OF THE LEG There are almost as many as there are in the forearm, but you only need to know three. Anteriorly there is TIBIALIS ANTERIOR (shin splints) Posteriorily there are GASTROCNEMIUS and SOLEUS. Both share a single tendon called the TENDO-CALCANEUS (ACHILLES TENDON: the mother of Achilles wanted her son to be immortal, so she picked him up by his heels and dipped him in the River of Immortality. The only spot that didn’t get wet was here, so he was vulnerable there, and was shot with an arrow there and killed.) The Gastrocnemius and Soleus are powerful, too, because they have to lift the entire body weight. 63 Muscles of the Leg tibialis anterior (H,C) o: upper 2/3 of tibia i: first metatarsal a: dorsiflexion and inversion of foot gastrocnemius (H,C) a: lateral and medial epicondyles of femur i: calcaneus via the tendocalcaneus (Achilles tendon) a: plantar flexion soleus (H,C) a: superior tibia and fibula i: calcaneus via the tendocalcaneus (Achilles tendon) a: plantar flexion 64 KNEE LIGAMENTS PATELLAR LIGAMENT is the tendon of the quadriceps femoris. Ligaments that stabilize the knee FIBIAL COLLATERAL (lateral) TIBIAL COLLATERAL (medial) These prevent lateral movement of the knee. If a football player has his weight on one leg and gets hit from the side, the lateral collateral ligament tears. Ligaments that prevent anterior-posterior motion and rotation ANTERIOR and POSTERIOR CRUCIATE LIGAMENT 65 Cartilage of the knee MEDIAL and LATERAL MENISCUS are cartilages for cushioning. These are what tears during a rotational injury = torn cartilage in the knee. Knees don’t heal very well; better to break a bone Ligaments of the knee lateral (fibular) collateral ligament medial (tibial) collateral ligament anterior cruciate ligament posterior cruciate ligament patellar ligament (Review) LAB EXAM II 66