Know The Body - Muscle PDF

SKELETAL MUSCLES OF THE BODY–ALPHABETICALLY
Abductor digiti minimi manus, 226 Fibularis group, 400 Mentalis, 322
Abductor digiti minimi pedis, 418 Fibularis longus, 400 Middle scalene, 282
Abductor hallucis, 418 Fibularis tertius, 400 Multifidus, 252
Abductor pollicis brevis, 222 Flexor carpi radialis, 198 Mylohyoid, 284
Abductor pollicis longus, 218 Flexor carpi ulnaris, 198 Nasalis, 318
Adductor brevis, 366 Flexor digiti minimi manus, 226 Obliquus capitis inferior, 276
Adductor group, 366 Flexor digiti minimi pedis, 424 Obliquus capitis superior, 276
Adductor hallucis, 424 Flexor digitorum brevis, 418 Obturator externus, 350
Adductor longus, 366 Flexor digitorum longus, 410 Obturator internus, 350
Adductor magnus, 366 Flexor digitorum profundus, 206 Occipitofrontalis, 310
Adductor pollicis, 232 Flexor digitorum superficialis, 206 Omohyoid, 288
Anconeus, 176 Flexor hallucis brevis, 424 Opponens digiti minimi, 226
Anterior abdominal wall muscles, 268 Flexor hallucis longus, 410 Opponens pollicis, 222
Anterior scalene, 282 Flexor pollicis brevis, 222 Orbicularis oculi, 314
Articularis genus, 376 Flexor pollicis longus, 206 Orbicularis oris, 322
Auricularis group, 310 Flexors digitorum and pollicis Palmar interossei, 232
Biceps brachii, 170 group, 206 Palmaris brevis, 230
Biceps femoris, 378 Gastrocnemius, 404 Palmaris longus, 198
Brachialis, 172 Geniohyoid, 284 Pectineus, 366
Brachioradialis, 204 Gluteal group, 346 Pectoralis group, 154
Buccinator, 322 Gluteus maximus, 346 Pectoralis major, 154
Central compartment group, 232 Gluteus medius, 346 Pectoralis minor, 154
Coracobrachialis, 168 Gluteus minimus, 346 Piriformis, 350
Corrugator supercilii, 314 Gracilis, 366 Plantar interossei, 428
Deep distal four group, 218 Hamstring group, 378 Plantar layer I (intrinsic foot), 418
Deep lateral rotator group, 350 Hypothenar eminence group, 226 Plantar layer II (intrinsic foot), 422
Deltoid, 166 Iliacus, 360 Plantar layer III (intrinsic foot), 424
Depressor anguli oris, 322 Iliocostalis, 250 Plantar layer IV (intrinsic foot), 428
Depressor labii inferioris, 322 Iliopsoas, 360 Plantaris, 408
Depressor septi nasi, 318 Inferior gemellus, 350 Platysma, 322
Diaphragm, 266 Infrahyoid muscles, 288 Popliteus, 414
Digastric, 284 Infraspinatus, 162 Posterior scalene, 282
Dorsal interossei manus, 232 Intercostal group, 260 Prevertebral group, 292
Dorsal interossei pedis, 428 Internal abdominal oblique, 268 Procerus, 318
Dorsal surface (intrinsic foot), 416 Internal intercostals, 260 Pronator group, 202
Erector spinae group, 250 Interspinales, 254 Pronator quadratus, 202
Extensor carpi radialis brevis, 210 Intertransversarii, 254 Pronator teres, 202
Extensor carpi radialis longus, 210 Lateral pterygoid, 306 Psoas major, 360
Extensor carpi ulnaris, 210 Latissimus dorsi, 158 Psoas minor, 364
Extensor digiti minimi, 214 Levator anguli oris, 322 Pterygoid group, 306
Extensor digitorum, 214 Levator labii superioris, 322 Quadratus femoris, 350
Extensor digitorum brevis, 416 Levator labii superioris alaeque Quadratus lumborum, 258
Extensor digitorum longus, 398 nasi, 322 Quadratus plantae, 422
Extensor hallucis brevis, 416 Levator palpebrae superioris, 314 Quadriceps femoris group, 372
Extensor hallucis longus, 396 Levator scapulae, 150 Rectus abdominis, 268
Extensor indicis, 218 Levatores costarum, 262 Rectus capitis anterior, 292
Extensor pollicis brevis, 218 Longissimus, 250 Rectus capitis lateralis, 292
Extensor pollicis longus, 218 Longus capitis, 292 Rectus capitis posterior major, 276
Extensors digitorum and digiti Longus colli, 292 Rectus capitis posterior minor, 276
minimi, 214 Lumbricals manus, 232 Rectus femoris, 372
External abdominal oblique, 268 Lumbricals pedis, 422 Rhomboid major, 148
External intercostals, 260 Masseter, 304 Rhomboid minor, 148
Fibularis brevis, 400 Medial pterygoid, 306 Risorius, 322
CONTENTS AT A GLANCE
Rotator cuff group, 162
Rotatores, 252 Chapter 1: Basic Kinesiology Terminology, 1 1
Sartorius, 358
Scalene group, 282 Chapter 2: The Skeletal System, 41 2
Semimembranosus, 378
Semispinalis, 252 Chapter 3: How Muscles Function, 87 3
Semitendinosus, 378
Serratus anterior, 152 Chapter 4: How to Palpate, 101 4
Serratus posterior group, 256
Serratus posterior inferior, 256 Chapter 5: Bony Palpation, 117 5
Serratus posterior superior, 256
Spinalis, 250 Chapter 6: Muscles of the Shoulder Girdle and Arm, 141 6
Soleus, 404
Splenius capitis, 274
Chapter 7: Muscles of the Forearm and Hand, 181 7
Splenius cervicis, 274 Chapter 8: Muscles of the Spine and Rib Cage, 241 8
Splenius group, 274
Sternocleidomastoid, 280 Chapter 9: Muscles of the Head, 299 9
Sternohyoid, 288
Sternothyroid, 288 Chapter 10: Muscles of the Pelvis and Thigh, 339 10
Stylohyoid, 284
Subclavius, 157 Chapter 11: Muscles of the Leg and Foot, 385 11
Subcostales, 264
Suboccipital group, 276 Appendix: Stretching Atlas, 435
Subscapularis, 162
Superior gemellus, 350 Bibliography, 449
Supinator, 216
Suprahyoids, 284 Index, 451
Supraspinatus, 162
Temporalis, 304
Temporoparietalis, 310
Tensor fasciae latae, 356
Teres major, 158
Teres minor, 162
Thenar eminence group, 222
Thyrohyoid, 288
Tibialis anterior, 394
Tibialis posterior, 410
Tom, Dick, and Harry group, 410
Transversospinalis group, 252
Transversus abdominis, 268
Transversus thoracis, 264
Trapezius, 146
Triceps brachii, 174
Triceps surae group, 404
Vastus intermedius, 372
Vastus lateralis, 372
Vastus medialis, 372
Wrist extensor group, 210
Wrist flexor group, 198
Zygomaticus major, 322
Zygomaticus minor, 322
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STUDENT RESOURCES:
sVideo Clips
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s Listen to author, Joe Muscolino, read aloud muscle names, attachments, and actions for every muscle
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KNOW
THE
BODY
Muscle, Bone, and Palpation Essentials
JOSEPH E. MUSCOLINO
Instructor, Purchase College
State University of New York
Purchase, New York
Owner, The Art and Science of Kinesiology
Stamford, Connecticut
3251 Riverport Lane
Maryland Height, Missouri 63043
KNOW THE BODY: MUSCLE, BONE, AND PALPATION ISBN 978-0-323-08684-4

ESSENTIALS, First Edition
Copyright © 2012 by Mosby, an Imprint of Elsevier, Inc.
All rights reserved. No part of this publication may be reproduced or transmitted in any form or by
any means, electronic or mechanical, including photocopy, recording, or any information storage
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Notice
Neither the Publisher nor the Author assume any responsibility for any loss or injury and/or
damage to persons or property arising out of or related to any use of the material contained in
this book. It is the responsibility of the treating practitioner, relying on independent expertise
and knowledge of the patient, to determine the best treatment and method of application for
the patient.
The Publisher
ISBN 978-0-323-08684-4
Vice President: Linda Duncan

Executive Content Strategist: Kellie White
Senior Content Development Specialist: Jennifer Watrous
Content Coordinator: Emily Thomson
Publishing Services Manager: Gayle May
Design Direction: Teresa McBryan
Printed in the United States of America
Last digit is the print number: 9 8 7 6 5 4 3 21

This book is dedicated to all
students of manual and movement
therapies who are taking their
rightful place in the field of
Integrative Healthcare.
This page intentionally left blank
Preface
Know the Body: Muscle, Bone, and Palpation Essentials, and muscles of the body. The goal of this book is to
is meant to be the best single source for all the essen- enable the student, therapist, trainer, or physician to
tial knowledge about the musculoskeletal system that a be able to critically think through muscle functioning
massage therapist or any manual or movement therapist when working clinically with clients and patients.
needs. Attachments (origins and insertions), actions
(regular and stabilization functions), and palpation are
covered for all the major muscles and muscle groups of ORGANIZATION
the body, as well as applications to treatment. In addi-
tion, this book contains five introductory chapters that Know the Body is organized into two major parts.
cover basic kinesiology terminology, bones and bony
landmarks, how muscles function, how to palpate, and
palpation of bones and bony landmarks. All the essen-
Part One
tials that you need to know are contained in this one Chapter 1 covers all the essential kinesiology terminol-
book, along with online demonstration videos on how ogy that a therapist needs to be able understand and
to palpate individual muscles and an interactive CD at communicate about the musculoskeletal system.
the back of the book that allows the viewer to place any Chapter 2 is an atlas of the skeletal system, cover-
combination of muscles on the skeleton to learn not ing all the bones, bony landmarks, muscle attachment
just each individual muscle, but also the relative rela- sites, and joints of the body.
tionship of muscles! Chapter 3 is a critically important chapter because
it explains clearly and concisely how the muscular sys-
tem functions. This chapter not only provides a strong
foundation to be able to learn the muscles of the body,
WHO WILL BENEFIT FROM THIS BOOK? but it also teaches the reader to critically think through
This book is written primarily for students and prac- muscle function and apply it in clinical settings.
ticing therapists of manual and movement therapies, Chapter 4 is another critically important chapter
including massage therapy, physical therapy, occu- because it teaches the art and science of palpation.
pational therapy, chiropractic, osteopathy, orthope- With the knowledge presented in this chapter, the
dics, athletic training, yoga, Pilates, and Feldenkrais. therapist will learn how to reason through muscle pal-
However, anyone who needs to learn the skeletal mus- pation protocols instead of simply memorizing them.
cles of the body will find this book invaluable and an Chapter 5 is an atlas of palpation of the bones and
essential resource. This book will be your guide as you major bony landmarks of the body—all with clear and
first learn the muscles of the body, and it will remain simple illustrations.
an invaluable resource on your bookshelf for as long
as you are in practice.
Part Two
Chapters 6 through 11 are the meat of this book. They
CONCEPTUAL APPROACH divide the body into regions and cover all the essen-
tials for every major muscle and muscle group within
The approach taken by Know the Body: Muscle, Bone, the region. Each chapter contains beautiful cutting-edge
and Palpation Essentials is to clearly and concisely pre- illustrations of the muscles of the region drawn onto a
sent all the essential information that needs to be skeleton and placed over a photograph of a real person.
learned about the musculoskeletal system. The begin- Functional guidelines present how to reason through
ning chapters set the framework for how muscles the actions of the groups of muscles presented. Each
work and how to palpate, as well as offer a five-step muscle or muscle group are then presented individu-
approach to learning muscles. The later chapters then ally, with attachments (origins and insertions), actions,
provide the application of this knowledge to the bones stabilization functions, innervation, palpation, and
vii
viii Preface
treatment considerations given. Review questions and COMPANION CD

case studies are also provided at the end of each chapter.
Chapter 6 covers the muscles of the shoulder girdle Know the Body includes a unique, interactive CD. A base
and arm. photograph of the region of the body is presented with
Chapter 7 covers the muscles of the forearm and the skeleton drawn in. A list of every muscle of that
hand. region is given; and you can choose any combination
Chapter 8 covers the muscles of the spine and rib of muscles and place them onto the illustration, allow-
cage. ing you to not only see that muscle’s attachments, but,
Chapter 9 covers the muscles of the head. more importantly, to be able to see the relationship
Chapter 10 covers the muscles of the pelvis and between all the muscles of the region. Any combina-
thigh. tion of muscles can be chosen!
Chapter 11 covers the muscles of the leg and foot.
An illustrated stretching atlas concludes the book,
featuring drawings of stretches for all major muscles. EVOLVE ONLINE RESOURCES
Know the Body is supported by an Evolve website that
DISTINCTIVE FEATURES includes the following student resources:
Q Downloadable audio pronunciations of muscle
Know the Body has many distinctive features: names, attachments, and actions
Q The most thorough yet concise muscle atlas for Q Palpation video clips covering skeletal muscles of
attachments, actions, and palpation the human body
Q Palpation of the bones and bony landmarks Q Crossword puzzles
Q Explanations and guidelines that promote critical Q Bony palpation matching activities
thinking to understand muscle actions Q Electronic coloring book
Q Beautiful illustrations in which the bones and mus-
cles are placed on a photograph of a real person Access these resources at http://evolve.elsevier.com/
Q Large group illustrations for every functional muscle Muscolino/knowthebody.
group
Q Online video coverage of the palpation protocols
for individual muscles of the body RELATED PUBLICATIONS
Q Treatment considerations for application to clinical
settings Know the Body: Muscle, Bone, and Palpation Essentials
Q An interactive CD that allows for any combination is supported by an excellent student workbook,
of muscles to be placed on the skeleton and body Workbook for Know the Body, that provides multiple
learning exercises for learning the content. Not only
does the student workbook follow Know the Body
LEARNING AIDS chapter by chapter, providing cross reference page
numbers for all of the content covered by the exercises,
Q Know the Body is meant to be used not only as a each chapter of the workbook is divided into sections
textbook but also as an in-class manual. that amount to roughly 1 week's amount of content.
Q Arrows are placed over the muscle for each indi- This workbook allows for periodic and regular review
vidual muscle illustration so that the line of pull of the material being learned!
of the muscle can be seen and visually understood. For more information on the musculoskeletal sys-
This feature allows for the actions of the muscle to tem, see Dr. Joe Muscolino's other publications:
be understood instead of memorized. Q The Muscular System Manual: The Skeletal Muscles
Q A “Treatment Considerations” section is provided of the Human Body, third edition: the most thor-
that offers interesting insights to each muscle. Many ough muscle atlas on the market.
of these are clinical applications that flesh out and Q Kinesiology: The Skeletal System and Muscle Function,
make learning the muscle more interesting. second edition: the most straightforward and
Q Review questions and case studies are placed at the thorough book on how the musculoskeletal sys-
end of each chapter to help the reader grasp how tem functions written for manual and movement
well he or she understands the content. therapists.
Q A companion student workbook is available that Q The Muscle and Bone Palpation Manual: With Trigger
provides multiple learning exercises and follows Points, Referral Patterns, and Stretching: the authori-
Know the Body: Muscle, Bone, and Palpation Essentials, tative guide to muscle palpation, trigger points,
chapter for chapter. and stretching.
Preface ix
Q Musculoskeletal Anatomy Flashcards, second edition: NOTE TO THE STUDENT

supports The Muscular System Manual: The Skeletal
Muscles of the Human Body, third edition. Learning the musculoskeletal system can often feel
Q Flashcards for Bones, Joints, and Actions of the overwhelming at first. This book presents the content
Human Body, second edition: supports Kinesiology: in an approachable manner that will make learning
The Skeletal System and Muscle Function, second this material fun! It also presents the content in a clear
edition. and straightforward manner that encourages you to
Q Flashcards for Palpation, Trigger Points, and Referral think through the content so that you better under-
Patterns: supports The Muscle and Bone Palpation stand it and can apply it to your clients when you are
Manual: With Trigger Points, Referral Patterns, and in practice. This makes learning not just fun and easy
Stretching. but better! Whether as an in-class manual or a refer-
Q Mosby's Trigger Point Flip Chart, with Referral Patterns ence text for your bookshelf, you will find this book to
and Stretching. be an ideal and essential book now and into the future!
Acknowledgments
One name sits on the front cover of this book; but they feel like family and include Kellie White, my
this is very misleading because the contribution acquisitions editor, Emily Thomson, editorial assis-
of so many people have made this book possible. tant, Gayle May and Dana Peick, production manag-
Acknowledgments are the author’s opportunity to ers, and Jennifer Watrous, my developmental editor.
thank all these wonderful people. Jennifer shares so much of my book projects with me;
Know the Body: Muscle, Bone, and Palpation Essentials at some point, I will simply need to add her name to
is a melding of the “essential” components of a num- the front cover. Thank you also to Kenneth Hewes,
ber of my other books, all wrapped into one guide for Jeffrey Simancek, and Wanda Reyes for reviewing the
students. As such, I need to start by thanking every initial outline of this book and helping mold its for-
individual who contributed to every one of those mat, and again to Kenneth Hewes for contributing
books. Thank you again! to the case studies. A special thank you goes to Chris
In addition, I must single out the wonderful art team Jones and Selena Anduze for stepping in at the last
that created the artwork in this book—Jean Luciano moment and helping me organize much of the work-
of Connecticut, Jeanne Robertson of Missouri, Frank book content.
Forney and David Carlson of Colorado, Peter Bull of A continual thank you to William Courtland, a pre-
England, and Jodie Bernard and Giovanni Rimasti vious student and now fellow instructor, who one day,
of Lightbox Visuals from our wonderful neighbor to many years ago said, “You should write a book.” Those
the north, Canada. Superb photography was done by words launched my writing career.
Yanik Chauvin, also out of Canada. As always, my tremendous love and appreciation to
My team at Mosby of Elsevier was, as usual, amaz- everyone in my family, especially Simona Cipriani, my
ing and wonderful to work with. At this point in time, angel, my love, and my partner in life.
xi
About the Author
Dr. Joe Muscolino has been a massage massage, stretching and advanced
and manual and movement therapy stretching, joint mobilization, pal-
educator for 25 years. He teaches pation, orthopedic assessment,
anatomy, physiology, kinesiology, musculoskeletal pathologic condi-
pathology, assessment, and treatment tions, anatomy and physiology, kine-
courses both in core curriculum and siology, and cadaver workshops.
in continuing education. Currently, He offers a Certificate Program in
he is an adjunct professor at Purchase Clinical Orthopedic Massage Therapy
College, State University of New York, (COMT), and he also runs instructor
where he teaches anatomy, physiol- in-services for kinesiology instructors.
ogy, and nutrition. Dr. Muscolino has He is an approved provider of con-
also published the following texts: tinuing education (CE); and CE credit
Q The Muscular System Manual: The is available through the NCBTMB for
Skeletal Muscles of the Human Body, Massage Therapists and Bodyworkers
third edition toward certification renewal.
Q Kinesiology: The Skeletal System and Muscle Function, Dr. Joe Muscolino holds a Bachelor of Arts degree
second edition in Biology from the State University of New York at
Q The Muscle and Bone Palpation Manual, with Trigger Binghamton, Harpur College. He attained his Doctor of
Points, Referral Patterns, and Stretching Chiropractic Degree from Western States Chiropractic
Q Musculoskeletal Anatomy Coloring Book, second College in Portland, Oregon, and is licensed in
edition Connecticut, New York, and California. Dr. Muscolino
Q Musculoskeletal Anatomy Flashcards, second edition has been in private practice in Connecticut for more
Q Flashcards for Bones, Joints, and Actions of the than 26 years and incorporates soft tissue work into
Human Body, second edition his chiropractic practice for all of his patients.
Q Flashcards for Palpation, Trigger Points, and Referral If you would like further information regarding
Patterns Know the Body: Muscle, Bone, and Palpation Essentials,
Q Mosby’s Trigger Point Flip Chart with Referral or any of Dr. Muscolino’s other publications, or
Patterns and Stretching if you are an instructor and would like informa-
His texts have been translated into seven foreign tion regarding the many supportive materials such
languages. as PowerPoint slides, test banks of questions, or
Dr. Muscolino writes the column article, “Body TEACH instructor’s manuals, please visit http://www.
Mechanics,” in The Massage Therapy Journal (MTJ). elsevieradvantage.com. If you would like information
He has also written for the Journal of Bodywork and regarding Dr. Muscolino’s workshops or if you would
Movement Therapies (JBMT), Massage Magazine, Massage like to contact Dr. Muscolino directly, please visit his
Today, and several massage journals in Australia and website: www.learnmuscles.com. You can also follow
New Zealand. him on his Facebook page, The Art and Science of
Dr. Muscolino teaches continuing education work- Kinesiology.
shops on such topics as body mechanics, deep tissue
xiii
Contents
Chapter 1: Basic Kinesiology, 1 Chapter 5: Bony Palpation, 117

Major Body Parts, 2 Upper Extremity, 117
Anatomic Position, 2 Axial Body, 124
Location Terminology, 2 Lower Extremity, 131
Planes, 5
Axes, 8
Chapter 6: Muscles of the Shoulder
Movement Terminology, 8
Girdle and Arm, 141
Joint Action Atlas, 11
Overview of Function: Muscles of the Shoulder
Girdle, 141
Chapter 2: The Skeletal System, 41 Overview of Function: Muscles of the
The Skeleton, 41 Glenohumeral Joint, 142
Joints, 41 Overview of Function: Muscles of the Elbow
Atlas of Bony Landmarks and Muscle and Radioulnar Joints, 142
Attachment Sites on Bones, 48 Trapezius, 146
Rhomboid Major; Rhomboid Minor, 148
Levator Scapulae, 150
Chapter 3: How Muscles Function, 87 Serratus Anterior, 152
Muscles Create Pulling Forces, 87 Pectoralis Group:
What Is a Muscle Contraction? 88 Pectoralis Major; Pectoralis Minor, 154
Naming a Muscle’s Attachments: Origin Detour to Subclavius, 157
and Insertion versus Attachments, 91 Latissimus Dorsi (Lat); Teres Major, 158
Eccentric Contractions, 91 Rotator Cuff Group:
Isometric Contractions, 92 Supraspinatus; Infraspinatus; Teres Minor;
Roles of Muscles, 92 Subscapularis, 162
Sliding Filament Mechanism, 93 Deltoid, 166
Muscle Fiber Architecture 94 Coracobrachialis, 168
Learning Muscles, 94 Biceps Brachii, 170
Brachialis, 172
Chapter 4: How to Palpate, 101 Triceps Brachii, 174
Anconeus, 176
What Is Palpation? 102
Objectives of Palpation: Location
and Assessment, 102 Chapter 7: Muscles of the Forearm
When Do We Palpate? 103 and Hand, 181
How to Learn Palpation, 103 Overview of Function: Muscles of the Elbow
Palpation Guidelines, 104 and Radioulnar Joints, 182
xv
xvi Contents
Overview of Function: Muscles of the Wrist Erector Spinae Group:

Joint, 182 Iliocostalis; Longissimus; Spinalis, 250
Overview of Function: Muscles of the Transversospinalis Group:
Fingers, 183 Semispinalis; Multifidus; Rotatores, 252
Wrist Flexor Group: Interspinales; Intertransversarii, 254
Flexor Carpi Radialis; Palmaris Longus; Serratus Posterior Group:
Flexor Carpi Ulnaris, 198 Serratus Posterior Superior; Serratus
Pronator Group: Posterior Inferior, 256
Pronator Teres; Pronator Quadratus, 202 Quadratus Lumborum (QL), 258
Brachioradialis, 204 Intercostal Group:
Flexors Digitorum and Pollicis Group: External Intercostals; Internal Intercostals,
Flexor Digitorum Superficialis; Flexor 260
Digitorum Profundus; Flexor Pollicis Levatores Costarum, 262
Longus, 206 Subcostales; Transversus Thoracis, 264
Wrist Extensor Group: Diaphragm, 266
Extensor Carpi Radialis Longus; Extensor Anterior Abdominal Wall Muscles:
Carpi Radialis Brevis; Extensor Carpi Rectus Abdominis; External Abdominal
Ulnaris, 210 Oblique; Internal Abdominal Oblique;
Extensor Digitorum; Extensor Digiti Minimi, 214 Transversus Abdominis, 268
Supinator, 216 Splenius Group:
Deep Distal Four Group: Splenius Capitis; Splenius Cervicis, 274
Abductor Pollicis Longus; Extensor Pollicis Suboccipital Group:
Brevis; Extensor Pollicis Longus; Extensor Rectus Capitis Posterior Major; Rectus
Indicis, 218 Capitis Posterior Minor; Obliquus Capitis
Thenar Eminence Group: Inferior; Obliquus Capitis Superior, 276
Abductor Pollicis Brevis; Flexor Pollicis Sternocleidomastoid (SCM), 280
Brevis; Opponens Pollicis, 222 Scalene Group:
Hypothenar Eminence Group: Anterior Scalene; Middle Scalene; Posterior
Abductor Digiti Minimi Manus; Flexor Digiti Scalene, 282
Minimi Manus; Opponens Digiti Suprahyoid Muscles:
Minimi, 226 Digastric; Stylohyoid; Mylohyoid;
Palmaris Brevis, 230 Geniohyoid, 284
Central Compartment Group: Infrahyoid Muscles:
Adductor Pollicis; Lumbricals Manus; Palmar Sternohyoid; Sternothyroid; Thyrohyoid;
Interossei; Dorsal Interossei Manus, 232 Omohyoid, 288
Prevertebral Group:
Chapter 8: Muscles of the Spine Longus Colli; Longus Capitis; Rectus Capitis
and Rib Cage, 241 Anterior; Rectus Capitis Lateralis, 292
Overview of Function: Muscles of the Spinal
Joints, 241 Chapter 9: Muscles of the Head, 299
Overview of Muscles that Move the Overview of Function, 300
Mandible, 242 Temporalis; Masseter, 304
Overview of Function: Muscles of the Rib Pterygoid Group:
Cage, 242 Lateral Pterygoid; Medial Pterygoid, 306
Contents xvii
Muscles of the Scalp: Hamstring Group:

Occipitofrontalis; Temporoparietalis; Biceps Femoris; Semitendinosus;
Auricularis Group, 310 Semimembranosus, 378
Muscles of Facial Expression—Eye:
Orbicularis Oculi; Levator Palpebrae Chapter 11: Muscles of the Leg
Superioris; Corrugator Supercilii, 314 and Foot, 385
Muscles of Facial Expression—Nose: Overview of Function: Muscles of the Ankle and
Procerus; Nasalis; Depressor Septi Subtalar Joints, 386
Nasi, 318 Overview of Function: Muscles of the Toes, 386
Muscles of Facial Expression—Mouth: Tibialis Anterior, 394
Levator Labii Superioris Alaeque Nasi; Extensor Hallucis Longus, 396
Levator Labii Superioris; Zygomaticus Extensor Digitorum Longus, 398
Minor; Zygomaticus Major; Levator Anguli Fibularis Group:
Oris; Risorius; Buccinator; Depressor Fibularis Longus; Fibularis Brevis; Fibularis
Anguli Oris; Depressor Labii Inferioris; Tertius, 400
Mentalis; Orbicularis Oris; Platysma, 322 Triceps Surae Group:
Gastrocnemius; Soleus, 404
Chapter 10: Muscles of the Pelvis Plantaris, 408
and Thigh, 339 Tom, Dick, and Harry Group:
Overview of Function: Muscles of the Hip Tibialis Posterior; Flexor Digitorum Longus;
Joint, 339 Flexor Hallucis Longus, 410
Overview of Function: Muscles of the Spinal Popliteus, 414
Joints, 340 Intrinsic Foot—Dorsal Surface:
Overview of Function: Muscles of the Knee Extensor Digitorum Brevis; Extensor Hallucis
Joint, 340 Brevis, 416
Gluteal Group: Intrinsic Foot—Plantar Layer I:
Gluteus Maximus; Gluteus Medius; Gluteus Abductor Hallucis; Abductor Digiti Minimi
Minimus, 346 Pedis; Flexor Digitorum Brevis, 418
Deep Lateral Rotator Group: Intrinsic Foot—Plantar Layer II:
Piriformis; Superior Gemellus; Obturator Quadratus Plantae; Lumbricals Pedis, 422
Internus; Interior Gemellus; Obturator Intrinsic Foot—Plantar Layer III:
Externus; Quadratus Femoris, 350 Flexor Hallucis Brevis; Flexor Digiti Minimi
Tensor Fasciae Latae, 356 Pedis; Adductor Hallucis, 424
Sartorius, 358 Intrinsic Foot—Plantar Layer IV:
Iliopoas: Plantar Interossei; Dorsal Interossei
Iliacus; Psoas Major, 360 Pedis, 428
Psoas Minor, 364 Appendix: Stretching Atlas, 435
Adductor Group: Bibliography, 449
Adductor Longus; Adductor Brevis; Adductor Index, 451
Magnus; Pectineus; Gracilis, 366
Quadriceps Femoris Group (Quads):
Rectus Femoris; Vastus Lateralis; Vastus
Medialis; Vastus Intermedius, 372
Articularis Genus, 376
CHAPTER
Basic Kinesiology
Terminology 1
CHAPTER OUTLINE
Major body parts, 2 Right lateral Fingers two through
Anatomic position, 2 deviation/left lateral five at the meta-
deviation, 9 carpophalangeal
Location terminology, 2
Pronation/supination, 9 and interphalangeal
Pairs of terms, 2 joints, 19
Inversion/eversion, 10
Anterior/posterior, 2 Thumb at the
Dorsiflexion/plantar-
Medial/lateral, 2 carpometacarpal
flexion, 10
Superior/inferior, 2 joint, 20
Opposition/
Proximal/distal, 2 Axial body, 21
reposition, 10
Superficial/deep, 4 Head at the atlanto-
Upward rotation/down-
occipital joint, 21
Radial/ulnar, 4 ward rotation, 10
Neck at the cervical
Tibial/fibular, 4 Lateral tilt/medial tilt
spinal joints, 23
Palmar/dorsal, 4 and upward tilt/
downward tilt, 10 Trunk at the
Plantar/dorsal, 4 thoracolumbar spinal
Horizontal flexion/
Cranial/caudal, 4 joints, 24
horizontal
Combining terms of extension, 10 Pelvis at the
location, 4 lumbosacral joint, 26
Hyperextension and
Planes, 5 circumduction, 10 Mandible at the
Motion of the Body within temporomandibular
Joint action atlas, 11
Planes, 7 joints (TMJs), 29
Upper extremity, 11
Axes, 8 Lower extremity, 30
Scapula at the
Movement terminology, 8 Thigh at the hip joint, 30
scapulocostal joint, 11
Pairs of Terms, 9 Pelvis at the hip
Clavicle at the sterno-
joint, 32
Flexion/extension, 9 clavicular joint, 13
Leg at the knee joint, 35
Abduction/adduction, 9 Arm at the glenohumeral
joint, 14 Foot at the ankle
Right lateral flexion/left
joint, 36
lateral flexion, 9 Reverse action of the
scapula and trunk Foot at the subtalar
Lateral rotation/medial
at the glenohumeral (tarsal) joint, 36
rotation, 9
joint, 15 Foot at the subtalar and
Right rotation/left
Forearm at the elbow ankle joints, 37
rotation, 9
and radioulnar joints, Toes at the metatarso-
Elevation/depression, 9
17 phalangeal and
Protraction/ interphalangeal
Hand at the wrist joint,
retraction, 9 joints, 38
18
1
2 Know the Body: Muscle, Bone, and Palpation Essentials
1
D iscussing muscle function without fluency in the
language of kinesiology is not possible (Box 1-1).
Specific kinesiology terms exist to help us avoid the
ANATOMIC POSITION
Anatomic position is a standard reference position that
ambiguities of lay language. Therefore embracing and is used to define terms that describe the physical loca-
using these terms is extremely important in the field of tion of structures of the body and points on the body.
health care, where a person’s health depends on clear In anatomic position, the person is standing erect, fac-
communication. The purpose of this chapter is to pro- ing forward, with the arms at the sides, the palms facing
vide an overview of the basic terms of kinesiology. (For forward, and the fingers and toes extended (Figure 1-2).
an in-depth and thorough discussion of the terminology
of kinesiology, see Kinesiology: The Skeletal System Note: Given that movement terminology is based on location
and Muscle Function, 2nd edition [Elsevier, 2011].) terminology, anatomic position is ultimately the foundation
for movement terminology as well.
BOX 1-1
LOCATION TERMINOLOGY
The term kinesiology literally means the study of motion.
Given that motion of our body occurs when bones move Now that anatomic position has been defined, it can
at joints, and that muscles are the primary creator of the be used as the reference position for location terms
forces that move the bones, kinesiology is the study of that describe the relative locations of body parts, struc-
the musculoskeletal system. Because the muscles are tures, and points on the body to each other. Location
controlled and directed by the nervous system, it might terminology is made up of directional terms that come
be more accurate to expand kinesiology to be the study in pairs, each member of the pair being the opposite
of the neuromusculoskeletal system.
of the other.
Pairs of Terms
Anterior/Posterior
MAJOR BODY PARTS
Anterior means farther to the front; posterior means far-
Motions of the body involve the movement of body ther to the back. These terms can be used for the entire
parts. To be able to describe the motion of body parts, body, axial and appendicular.
each part must be accurately named. Figure 1-1 illus-
trates the major divisions and body parts of the human Note: The term ventral is sometimes used for anterior, and
body. The axial body and the appendicular body are the term dorsal is sometimes used for posterior. The true
the two major divisions. The appendicular body can definition of ventral is the soft belly surface of a body part;
be divided into the upper and the lower extremities. dorsal refers to the harder surface on the other side of
The names of most body parts are identical to the the body part. In the lower extremity, anterior/ventral and
lay English names. However, a few cases exist where posterior/dorsal are not synonymous. The ventral surface
kinesiology terms are very specific and need to be of the thigh is the medial surface; of the leg is the posterior
observed. For example, the term arm is used to refer surface; of the foot is the plantar surface.
to the region of the upper extremity that is located
between the shoulder and elbow joints. The term fore- Medial/Lateral
arm refers to the body part that is located between Medial means closer to an imaginary midline that
the elbow and wrist joints; the forearm is a separate divides the body into the left and right halves. Lateral
body part and is not considered to be part of the arm. means farther from this imaginary midline. These terms
Similarly, the term leg describes the region of the lower can be used for the entire body, axial and appendicular.
extremity that is located between the knee and ankle
joints, whereas the term thigh is used to describe an Superior/Inferior
entirely separate body part that is located between the Superior means above (toward the head). Inferior
hip and knee joints; the thigh is not part of the leg. The means below (away from the head). These terms are
precise use of these terms is essential so that move- usually used for the axial body only.
ments of the leg and thigh are not confused with one
another, and movements of the arm and forearm are Proximal/Distal
not confused with one another. Pelvis is another term Proximal means closer (i.e., more proximity) to the
that should be noted. The pelvis is a separate body axial body; distal means farther (i.e., more distant)
part from the trunk and is located between the trunk from the axial body. These terms are only used for the
and thighs. appendicular body.
Chapter 1 Basic Kinesiology Terminology 3
Head
1
Neck
Shoulder girdle
Axial body parts
Arm
Trunk Upper extremity body parts

Forearm
Pelvis
Hand
Thigh
Lower extremity body parts
Leg
Foot
A
Head
Neck
Axial body parts
Shoulder girdle
Arm
Trunk
Upper extremity body parts
Forearm
Pelvis
Hand
Thigh
Lower extremity body parts
Leg
Foot
B
FIGURE 1-1 The three major divisions of the body are the axial body and the two divisions
of the appendicular body. The appendicular body is composed of the upper extremities and
lower extremities. The body parts within these major divisions are shown. A, Anterior view.
B, Posterior view. Continued
Head
1
Neck
Axial
Shoulder girdle body parts
Upper Arm
extremity Trunk
body
parts
Forearm
Pelvis
Hand
Thigh
Lower
extremity
body parts
Leg
Foot
C
FIGURE 1-1, cont'd C, Lateral view. FIGURE 1-2 Anatomic position is a reference position of the
body in which the person is standing erect, facing forward, with
the arms at the sides, the palms facing forward, and the fingers
and toes extended.
Superficial/Deep Plantar/Dorsal
Superficial means closer to the surface of the body. The terms plantar and dorsal can be used for the foot.
Deep means farther from the surface of the body (i.e., The plantar surface of the foot is the undersurface that
more internal). These terms can be used for the entire is planted on the ground. The dorsal surface is the top
body, axial and appendicular. or dorsum of the foot.
Note: When using the terms superficial and deep, stating Cranial/Caudal
the perspective from which you are viewing the body is Cranial means toward the head; caudal means toward
always recommended. the “tail” of the body. These terms are only used for
the axial body.
Radial/Ulnar
The terms radial and ulnar can be used for the fore-
arm and hand in place of the terms lateral and medial,
respectively. The radius is the lateral bone of the fore- Combining Terms of Location
arm; the ulna is the medial bone. Similar to combining terms such as north and west
to create northwest, location terms can be combined.
Tibial/Fibular When doing this, the end of the first word is usu-
The terms tibial and fibular can be used for the leg and ally dropped, and the letter o is placed to connect
sometimes the foot in place of the terms medial and the two words. For example, anterior and lateral
lateral, respectively. The tibia is the medial bone of the combine to become anterolateral. Although no hard
leg; the fibula is the lateral bone. and fast rule exists, anterior and posterior are usu-
ally placed first when combined with other terms.
Palmar/Dorsal Figure 1-3 is an anterior view of a person, illustrat-
The terms palmar and dorsal can be used for the hand in ing the terms of relative location as they pertain to
place of the terms anterior and posterior, respectively. the body.
ANATOMIC POSITION
Superior 1
(axial body only)
Proximal
(appendicular body only)
Inferior
(axial body only)
Distal
Proximal
Anterior toward the front
(entire body)
Ulnar Radial
Posterior toward the back (forearm and hand only)
(entire body)
Palmar often used in place

of anterior on the hand.
Dorsal often used in place

of posterior on the hand.
Plantar used for the inferior

surface of the foot. Tibial Fibular (leg only)
Dorsal used for the superior

surface of the foot. Distal
Lateral (entire body) Medial (entire body)
FIGURE 1-3 Various terms of location relative to anatomic position.
PLANES is perpendicular to the other two planes. Any plane

that is not perfectly sagittal, frontal, or transverse is
Planes are flat surfaces that cut through and can be described as an oblique plane. Therefore an oblique
used to map three-dimensional space. Because space plane has components of two or three cardinal planes.
is three-dimensional, three major planes, known as Figure 1-4 illustrates two examples each of the three
cardinal planes, exist. The three cardinal planes are cardinal planes and an oblique plane.
(1) sagittal, (2) frontal, and (3) transverse planes (Box
1-2). The sagittal plane divides the body into left and BOX 1-2
right portions. The frontal plane divides the body
into front and back (anterior and posterior) portions.
The transverse plane divides the body into upper The frontal plane is also known as the coronal plane. The
and lower (superior and inferior or proximal and transverse plane is also known as the horizontal plane.
distal) portions. Each of these three cardinal planes
A B
C D
FIGURE 1-4 Anterolateral views of the body illustrate the three cardinal planes (sagittal, frontal,
and transverse) and oblique planes. A, Two examples of sagittal planes. B, Two examples of
frontal planes. C, Two examples of transverse planes. D, Two examples of oblique planes. The
upper oblique plane has frontal and transverse components; the lower oblique plane has sagittal
and transverse components.
Motion of the Body within Planes sagittal and frontal planes are vertical and the trans-
Planes become extremely important when we describe verse plane is horizontal. Therefore motions within
the motion of a body part through space, because the sagittal and frontal planes move vertically up and 1
the body part moves within a plane. Hence, by defin- down and motions within the transverse plane move
ing the planes of space, we can describe the path of horizontally. Figure 1-5 illustrates examples of motion
motion of a body part when it moves. Note that the within the three cardinal planes and an oblique plane.
A B
C D
FIGURE 1-5 Examples of motion of body parts within planes. A, Motions of the head and neck
and forearm within sagittal planes. B, Motions of the head and neck and arm within frontal
planes. C, Motions of the head and neck and arm within transverse planes. D, Motions of the
head and neck and arm within oblique planes.
AXES MOVEMENT TERMINOLOGY

1 An axis (plural: axes) is an imaginary line around Using anatomic position, we are able to define terms
which a body part moves. If a body part moves in a that describe static locations on the body. We now
circular path around an axis, it is described as an axial need to define terms that describe dynamic move-
motion. If the body part moves in a straight line, it is ments of the body. These movement terms are called
described as a nonaxial motion. Both axial and non- joint actions. Similar to location terms, they come in
axial motions of a body part move within a plane. pairs in which each member of the pair is the opposite
However, an axial motion moves within a plane and of the other (Box 1-3). However, different from loca-
moves around an axis. The orientation of an axis for tion terms, movement terms do not describe a static
movement is always perpendicular to the plane within location; rather, they describe a direction of motion.
which the movement is occurring. The major pairs of joint action terms are defined here.
Each plane has its own corresponding axis; It should be noted that joint actions usually describe
therefore there are three cardinal axes. The axis for cardinal plane motions of a body part. For example, the
sagittal plane movements is oriented side to side brachialis muscle brings the forearm anteriorly in the
and described as the mediolateral axis, the axis for sagittal plane at the elbow joint; therefore its action is
frontal plane movements is oriented front to back described as flexion of the forearm at the elbow joint.
and described as anteroposterior, and the axis for If a muscle creates an oblique plane motion, then this
transverse plane movements is oriented up and down motion is described by breaking it into its component
and described as superoinferior or simply vertical. cardinal plane joint action motions. An example is the
Each oblique plane also has its own corresponding coracobrachialis muscle, which moves the arm anteri-
axis, which is perpendicular to it. Figure 1-6 illustrates orly (in the sagittal plane) and medially (in the fron-
axial motions that occur within planes and around tal plane). When describing this motion, it is said that
their corresponding axes. the coracobrachialis flexes and adducts the arm at the
A B C D
FIGURE 1-6 Anterolateral views illustrate the corresponding axes for the three cardinal planes and
an oblique plane; the axes are shown as red tubes. Note that an axis always runs perpendicular
to the plane in which the motion is occurring. A, Motion occurring in the sagittal plane around the
mediolateral axis. B, Motion occurring in the frontal plane around the anteroposterior axis. C, Motion
occurring in the transverse plane around the superoinferior axis or, more simply, the vertical axis.
D, Motion occurring in an oblique plane around an axis that is running perpendicular to that plane
(i.e., it is the oblique axis for this oblique plane).
middle finger can only abduct; it can perform radial

BOX 1-3 abduction and ulnar abduction.
The thumb abducts within the sagittal plane by 1
Pointing out that joint action terms describe cardinal moving away from the palm of the hand; it adducts
plane motions is extremely important. For example, within the frontal plane by moving back toward the
flexion and extension of the arm at the shoulder (gleno- palm. The terms abduction and adduction are used only
humeral) joint occur within the sagittal plane, abduction for the appendicular body.
and adduction of the arm at the glenohumeral joint
occur within the frontal plane, and right rotation and Right Lateral Flexion/Left Lateral Flexion
left rotation of the arm at the glenohumeral joint occur
Right lateral flexion is a side-bending movement of the
within the transverse plane. If the arm were to move in
head, neck, and/or trunk toward the right within the
an oblique plane, then to describe its motion, its cardinal
plane motion components must be stated. For example, frontal plane. Left lateral flexion is the opposite. These
if the arm moves in a straight line that is forward and terms are used only for the axial body.
toward the midline, it would be described as flexing and
adducting, even though it moves in only one direction. Lateral Rotation/Medial Rotation
Lateral rotation is a movement within the transverse
plane in which the anterior surface of the body part
shoulder (glenohumeral) joint. It actually causes one moves to face more laterally (away from the midline);
motion, but this one motion is described as having two medial rotation moves the anterior surface to face more
cardinal (sagittal and frontal) plane components. (For medially (toward the midline).
more information on this, see Kinesiology: The Skeletal Lateral rotation is also known as external rotation;
System and Muscle Function, 2nd edition [Elsevier, 2011].) medial rotation is also known as internal rotation.
Following the definitions of joint action terms is a These terms are used only for the appendicular body.
joint action atlas that contains illustrations that dem-
onstrate all the joint actions of the body. Right Rotation/Left Rotation
Right rotation is a movement within the transverse
Pairs of Terms plane in which the anterior surface of the body part
moves to face more to the right; left rotation moves the
Flexion/Extension anterior surface to face more to the left. These terms
Flexion is generally an anterior movement of a body are used for the axial body only.
part within the sagittal plane; extension is generally a
Note: The terms ipsilateral rotator and contralateral rotator
posterior movement within the sagittal plane.
are often used to describe muscles that produce right or
Exceptions include movements of the legs, feet,
left rotation. Ipsilateral and contralateral rotations are not
toes, and thumbs. From the knee joint and farther dis-
joint action terms. Rather, they are ways to describe that
tally, flexion of a body part moves posteriorly (exten-
a muscle on one side of the body either produces rotation
sion is therefore an anterior movement). The thumb
to that same (ipsilateral) side or to the opposite (contra-
moves medially within the frontal plane when it flexes
lateral) side.
and laterally within the frontal plane when it extends.
The terms flexion and extension can be used for the
entire body, axial and appendicular. Elevation/Depression
Elevation is a movement wherein the body part moves
Abduction/Adduction superiorly; depression occurs when the body part moves
Abduction is generally a lateral movement within the inferiorly.
frontal plane that is away from the imaginary midline
of the body; adduction is a medial movement toward Protraction/Retraction
the midline. Protraction is a movement wherein the body part
Exceptions include the toes and fingers, including moves anteriorly; retraction is a posterior movement of
the thumbs. the body part.
The toes adduct toward an imaginary line through
the center of the second toe when the second toe is in Right Lateral Deviation/Left Lateral Deviation
anatomic position; they abduct away from this imagi- Lateral deviation is a linear movement that occurs in
nary line. Toe number two can only abduct; it can per- the lateral direction.
form tibial abduction and fibular abduction.
Fingers two through five adduct toward an imagi- Pronation/Supination
nary line that goes through the center of the middle The terms pronation and supination can be applied to
finger when the middle finger is in anatomic posi- motion of the forearm at the radioulnar joints and
tion; they abduct away from this imaginary line. The motion of the foot at the subtalar (tarsal) joint.
Pronation of the forearm results in the posterior

Note: These actions of the scapula and clavicle cannot be
surface of the radius facing anteriorly (when in ana-
isolated. Rather, they must couple with motions of the arm
1 tomic position); supination is the opposite.
at the glenohumeral joint.
Note: Forearm pronation is easily confused with medial
rotation of the arm at the glenohumeral joint and forearm
Lateral Tilt/Medial Tilt and Upward
supination with lateral rotation of the arm.
Tilt/Downward Tilt
Pronation of the foot at the subtalar joint is a tri- The scapula laterally tilts when its medial border lifts
axial motion that is made up primarily of eversion; it away from the body wall; medial tilt is the opposite
also includes dorsiflexion and lateral rotation (also motion during which the medial border moves back
known as abduction) of the foot at the subtalar joint. toward the body wall.
Supination of the foot is primarily made up of inver- The scapula upwardly tilts when its inferior angle
sion; it also includes foot plantarflexion and medial lifts away from the body wall; downward tilt is the
rotation (also known as adduction) at the subtalar joint. opposite motion during which the inferior angle
moves back toward the body wall.
Inversion/Eversion
The foot inverts at the subtalar joint when it turns Horizontal Flexion/Horizontal Extension
its plantar surface toward the midline of the body; it Horizontal flexion is a movement of the arm or
everts when its plantar surface is turned outward away thigh in which it begins in a horizontal position (i.e.,
from the midline. Inversion is the principal compo- abducted to 90 degrees) and then moves anteriorly
nent of supination of the foot; eversion is the principal toward the midline of the body. Horizontal extension
component of pronation of the foot. is the movement in the opposite direction.
Dorsiflexion/Plantarflexion Note: Horizontal flexion is also known as horizontal

The foot dorsiflexes when it moves superiorly (in the adduction; horizontal extension is also known as horizontal
direction of its dorsal surface); it plantarflexes when abduction.
it moves inferiorly (in the direction of its plantar sur-
face). Technically, dorsiflexion is extension and plan-
Hyperextension and Circumduction
tarflexion is flexion.
Hyperextension
Opposition/Reposition The term hyperextension is often used to describe
The thumb opposes at the saddle (carpometacarpal) extension beyond anatomic position. This text does
joint when its pad meets the pad of another finger; not use hyperextension in this manner. Extension
it repositions when it returns back toward anatomic beyond anatomic position is called extension, just as
position. Opposition is actually a composite of abduc- flexion and abduction beyond anatomic position are
tion, flexion, and medial rotation of the thumb; repo- called flexion and abduction. The prefix hyper denotes
sition is a composite of adduction, extension, and lat- excessive, therefore the term hyperextension would be
eral rotation of the thumb. better and more consistently defined as a range of
extension motion that occurs beyond what is normal
Note: Medial rotation and lateral rotation in the transverse
or beyond what is healthy.
plane cannot occur in isolation; they must occur in conjunc-
tion with flexion and extension, respectively, Circumduction
The little finger can also oppose and reposition at Circumduction is not a joint action. Rather, circum-
its carpometacarpal joint. Little finger opposition is duction is a sequence of four joint actions performed
composed of flexion, adduction, and lateral rotation one after the other. For example, if a person moves
of the little finger; little finger reposition is composed his or her arm at the glenohumeral joint into flexion,
of extension, abduction, and medial rotation. then abduction, then extension, and then adduction,
and does this by rounding the corners of the four
Upward Rotation/Downward Rotation motions, it creates a circular motion pattern that is
The scapula upwardly rotates when its glenoid fossa called circumduction. It should also be noted that cir-
is moved to face more superiorly; downward rotation cumduction does not contain any rotation motion.
is the opposite motion. The clavicle upwardly rotates Any joint that allows motion within two or more
when its inferior surface moves to face anteriorly; planes (biaxial or triaxial joints) can allow circumduc-
downward rotation is the opposite motion. tion to occur.
JOINT ACTION ATLAS

1
Upper Extremity
Scapula at the Scapulocostal Joint
A B
C D
FIGURE 1-7 Nonaxial actions of elevation/depression and protraction/retraction of the scapula at

the scapulocostal joint. A, Elevation. B, Depression. C, Protraction. D, Retraction. The left scapula
is in anatomic position in all figures. (Note: All views are posterior.)
FIGURE 1-8 Upward rotation of the right scapula at the scapulocostal joint. The left scapula is
in anatomic position, which is full downward rotation. (Note: Scapular actions of upward and
downward rotation cannot be isolated. They must accompany humeral motion. In this case,
the humerus is abducted at the glenohumeral joint.) (Note: This is a posterior view.)
A B
FIGURE 1-9 Tilt actions of the right scapula at the scapulocostal joint. A, Lateral tilt: the left
scapula is in anatomic position of medial tilt. B, Upward tilt: the left scapula is in anatomic
position of downward tilt. (Note: Both views are posterior.)
Clavicle at the Sternoclavicular Joint

1
A B
FIGURE 1-10 A, Elevation of the right clavicle at the sternoclavicular joint. B, Depression of the
right clavicle. (Note: The left clavicle is in anatomic position. Both views are anterior.)
A B
FIGURE 1-11 A, Protraction of the right clavicle at the sternoclavicular joint. B, Retraction of the
right clavicle. (Note: Both views are anteroinferior.)
FIGURE 1-12 Anterior view illustrates upward rotation of the right clavicle at the sternoclavicular joint;
the left clavicle is in anatomic position, which is full downward rotation. (Note: Upward rotation
of the clavicle cannot be isolated. In this figure the arm is abducted at the glenohumeral joint,
resulting in the scapula upwardly rotating, which results in upward rotation of the clavicle.)
Arm at the Glenohumeral Joint

1
A B
FIGURE 1-13 Sagittal plane actions of the arm at the glenohumeral joint. A, Flexion. B, Extension.
(Note: Both views are lateral.)
A B
FIGURE 1-14 Frontal plane actions of the arm at the glenohumeral joint. A, Abduction.
B, Adduction. (Note: Both views are anterior.)
A B
FIGURE 1-15 Transverse plane actions of the arm at the glenohumeral joint. A, Lateral rotation.
B, Medial rotation. (Note: Both views are anterior.)
Reverse Action of the Scapula and Trunk at the Glenohumeral Joint
A B
FIGURE 1-16 Reverse actions in which the trunk moves relative to the arm at the glenohumeral
(GH) joint are also possible. In these illustrations, the trunk is seen to move relative to the arm
at the GH joint. A and B illustrate neutral position and right lateral deviation of the trunk at the
right GH joint, respectively. Continued
C D
E F
FIGURE 1-16, cont'd C and D illustrate neutral position and right rotation of the trunk at the right
GH joint, respectively; and E and F illustrate neutral position and elevation of the trunk at the
right GH joint, respectively. In all three cases, note the change in angulation between the arm
and trunk at the GH joint (for lateral deviation B and elevation F, the elbow joint has also flexed).
(Note: All views are anterior.)
Forearm at the Elbow and Radioulnar Joints

1
A B
FIGURE 1-17 Motions of the right forearm at the elbow joint. A, Flexion. B, Extension. (Note: Both
views are lateral.)
A B
FIGURE 1-18 Pronation and supination of the right forearm at the radioulnar joints. A, Pronation.
B, Supination, which is anatomic position for the forearm. (Note: Both views are anterior.)
Hand at the Wrist Joint

1
A B
FIGURE 1-19 Motions of the right hand at the wrist joint (radiocarpal and midcarpal joints). A and
B, Lateral views illustrate flexion and extension of the hand, respectively. C and D, Anterior views
illustrate radial deviation and ulnar deviation, respectively. Radial deviation of the hand is also
known as abduction; ulnar deviation is also known as adduction.
Fingers Two through Five at the Metacarpophalangeal and Interphalangeal Joints

1
A B
C D
E F
FIGURE 1-20 Actions of the fingers at the metacarpophalangeal (MCP) joints of the hand. A and
B, Radial (i.e., lateral) views illustrate flexion and extension, respectively, of fingers two through
five at the MCP joints. Flexion of the fingers at the interphalangeal joints is also seen. C and
D, Anterior views illustrate abduction and adduction of fingers two through four at the MCP
joints, respectively. E and F, Anterior views illustrate radial abduction and ulnar abduction of
the middle finger at the third MCP joint, respectively.
Thumb at the Carpometacarpal Joint

1 FIGURE 1-21 Actions of the thumb at
the first carpometacarpal (CMC) joint
(also known as the saddle joint of
the thumb). A and B, Anterior views
illustrate opposition and reposition of the
thumb, respectively. C and D, Anterior
views illustrate flexion and extension,
respectively; these actions occur within
the frontal plane. E and F, Lateral views
illustrate abduction and adduction,
respectively; these actions occur within
the sagittal plane. (Note: Flexion of the
phalanges of the thumb and/or little finger
at metacarpophalangeal joint is also seen
in A and C; flexion of the thumb at the
interphalangeal joint is also seen in C.)
A B
C D E F
Axial Body
Head at the Atlanto-Occipital Joint 1
A B
FIGURE 1-22 Lateral views illustrate sagittal plane motions of the head at the atlanto-occipital
joint. A, Flexion. B, Extension.
A B
FIGURE 1-23 Posterior views illustrate frontal plane lateral flexion motions of the head at the
atlanto-occipital joint. A, Left lateral flexion. B, Right lateral flexion.
A B
FIGURE 1-24 Posterior views illustrate transverse plane rotation motions of the head at the
atlanto-occipital joint. A, Left rotation; B, Right rotation.
Neck at the Cervical Spinal Joints

FIGURE 1-25 Motions of the neck at the 1
spinal joints. A and B are lateral views that
depict flexion and extension in the sagittal
plane, respectively. C and D are posterior
views that depict left lateral flexion and
right lateral flexion in the frontal plane,
respectively. E and F are anterior views
that depict right rotation and left rotation
in the transverse plane, respectively.
Note: A to F depict motions of the entire
craniocervical region (i.e., the head at the
atlanto-occipital joint and the neck at the
spinal joints).
A B
C D
E F
Trunk at the Thoracolumbar Spinal Joints

1
A B
FIGURE 1-26 Motions of the thoracolumbar spine (trunk) at the spinal joints. A and B, Lateral
views illustrate flexion and extension of the trunk, respectively, in the sagittal plane.
C D
E F
FIGURE 1-26, cont'd C and D, Anterior views illustrate right lateral flexion and left lateral flexion of
the trunk, respectively, in the frontal plane. E and F, Anterior views illustrate right rotation and left
rotation of the trunk, respectively, in the transverse plane.
Pelvis at the Lumbosacral Joint

1
A
Posterior tilt
B
Anterior tilt
FIGURE 1-27 Motion of the pelvis at the lumbosacral joint. A and B, Lateral views illustrate
posterior tilt and anterior tilt, respectively. (Note: In A and B, no motion is occurring at the hip
joints; therefore the thighs are seen to “go along for the ride,” resulting in the lower extremities
changing their orientation.)
C D
Elevation of the right pelvis Elevation of the left pelvis
FIGURE 1-27, cont'd C and D, Anterior views illustrate elevation of the right pelvis and elevation of
the left pelvis, respectively, at the lumbosacral joint. (Note: In illustrations of C and D, no motion is
occurring at the hip joints; therefore the thighs are seen to “go along for the ride,” resulting in the
lower extremities changing their orientation.) Continued
E F
Right rotation of the pelvis Left rotation of the pelvis
FIGURE 1-27, cont'd E and F, Anterior and superior views illustrate rotation of the pelvis to the right
and rotation to the left, respectively, at the lumbosacral joint. (Note: In E and F the dashed black
line represents the orientation of the spine and the red dotted line represents the orientation of the
pelvis. Given the different directions of these two lines, the pelvis has clearly rotated relative to the
spine; this motion has occurred at the LS joint.)
Mandible at the Temporomandibular Joints (TMJs)

1
A B
FIGURE 1-28 A and B, Lateral views illustrate depression and elevation, respectively, of the
mandible at the temporomandibular joints (TMJs). These are axial motions.
A B
FIGURE 1-29 A and B, Lateral views illustrate protraction and retraction, respectively, of the
mandible at the temporomandibular joints (TMJs). These are nonaxial glide motions.
A B
FIGURE 1-30 A and B, Anterior views illustrate right lateral deviation and left lateral deviation,
respectively, of the mandible at the temporomandibular joints (TMJs). These are nonaxial glide
motions.
Lower Extremity
Thigh at the Hip Joint
A B
FIGURE 1-31 Motions of the right thigh at the hip joint. A and B, Lateral views illustrate flexion
and extension, respectively.
C D
E F
FIGURE 1-31, cont'd C and D, Anterior views illustrate abduction and adduction, respectively.
E and F, Anterior views illustrate lateral rotation and medial rotation, respectively.
Pelvis at the Hip Joint

1
A B
Posterior tilt Anterior tilt
FIGURE 1-32 Motion of the pelvis at the hip joints. (Note: No motion is occurring in A to D at the
lumbosacral joint; therefore the trunk is seen to “go along for the ride,” resulting in the upper
body changing its orientation.) A and B, Lateral views illustrate posterior tilt and anterior tilt,
respectively.
C D
Depression of the right pelvis Elevation of the right pelvis
FIGURE 1-32, cont'd C and D, Anterior views illustrate depression of the right pelvis and elevation
of the right pelvis, respectively. (Note: When the pelvis elevates on one side, it depresses on the
other, and vice versa.) Continued
E F
Right rotation of the pelvis Left rotation of the pelvis
FIGURE 1-32, cont'd E and F, Anterior and superior views illustrate rotation of the pelvis to the
right and rotation to the left, respectively. (Note: In E and F the black dashed line represents the
orientation of the thighs and the red dotted line represents the orientation of the pelvis. Given the
different directions of these lines, the pelvis has clearly rotated relative to the thighs; this motion
has occurred at the hip joints.)
Leg at the Knee Joint

1
A B
C D
FIGURE 1-33 Motions possible at the right tibiofemoral (i.e., knee) joint. A and B, Lateral views
illustrate flexion and extension of the right leg at the knee joint, respectively. C and D, Anterior
views illustrate lateral and medial rotation of the right leg at the knee joint, respectively. (Note:
The knee joint can only rotate if it is first flexed.)
Foot at the Ankle Joint

1
A B
FIGURE 1-34 A and B, Lateral views illustrate dorsiflexion and plantarflexion of the right foot at
the talocrural (i.e., ankle) joint, respectively.
Foot at the Subtalar (Tarsal) Joint
A Pronation B Supination
FIGURE 1-35 A and B, Motions of the right foot at the subtalar (tarsal) joint. A, Pronation.
The principal component of pronation is eversion. B, Supination. The principal component of
supination is inversion.
Foot at the Subtalar and Ankle Joints

1
A B
Dorsiflexion
Plantarflexion
Eversion Inversion
Lateral rotation Medial rotation
FIGURE 1-36 Cardinal plane components of right foot motion at the subtalar and ankle joints.
A, Frontal plane components of eversion/inversion. B, Sagittal plane components of dorsiflexion/
plantarflexion. C, Transverse plane components of lateral rotation/medial rotation (abduction/
adduction). (Note: In A and B, the axis is represented by the red dot.)
Toes at the Metatarsophalangeal and Interphalangeal Joints

1
A B
C D
FIGURE 1-37 Motion of the toes at the

metatarsophalangeal (MTP) joints. A and
B, Lateral views illustrate flexion and
extension of the toes, respectively (at both
the MTP and interphalangeal joints). C and
D, Dorsal views illustrate abduction and
adduction of the toes at the MTP joints.
E, Fibular abduction of the second toe at
the MTP joint. F, Tibial abduction of the
second toe at the MTP joint.
E F
REVIEW QUESTIONS 1
Circle or fill in the correct answer for each of the following questions or statements. More study resources are provided
on the Evolve website at http://evolve.elsevier.com/Muscolino/knowthebody.
1. The arm begins at the _________________ joint, and 6. Which of the following terms describes the location
of the wrist joint relative to the elbow joint?
ends at the ___________________ joint. a. Inferior
b. Medial
2. What are the three cardinal planes? c. Proximal
d. Distal
________________________________________________
7. Which of the following terms best describes the
________________________________________________ location of the sternum relative to the hip joint?
a. Superomedial
________________________________________________ b. Anterolateral
c. Deep
3. What are the three cardinal axes? d. Posteromedial
________________________________________________ 8. As a general rule, in what direction does a body

part move when it flexes?
________________________________________________ a. Posterior
b. Anterior
________________________________________________ c. Medial
d. Lateral
4. The leg begins at the _______________ joint, and
ends at the ______________ joint(s). 9. Which of the following joint actions does not occur
a. Hip; ankle at the shoulder (glenohumeral) joint?
b. Hip; toe a. Right rotation
c. Hip; knee b. Flexion
d. Knee; ankle c. Abduction
d. Medial rotation
5. What term means closer to the midline of the
body? 10. Which of the following is true regarding
a. Anterior circumduction?
b. Superior a. It is always unhealthy.
c. Medial b. It is the same as rotation.
d. Proximal c. It involves rotation.
d. It is not an action.
CHAPTER
The Skeletal System
2
is lined internally by a synovial membrane, enclosing a
CHAPTER OUTLINE joint cavity that contains synovial fluid. Only synovial
The Skeleton, 41 joints possess a joint cavity and have articular cartilage
that covers the joint surfaces of the bones.
Joints, 41
Structural Classification of Joints, 41
Functional Classification of Joints, 41 Functional Classification of Joints
Types of Synovial Joints, 41 Functionally, a joint is defined by its ability to allow
motion between two (or more) bones. There are three
Uniaxial Joints, 41
functional classifications of joints: (1) synarthrotic,
Biaxial Joints, 44 (2) amphiarthrotic, and (3) diarthrotic. Synarthrotic
Triaxial Joints, 45 joints permit very little motion; amphiarthrotic joints
Nonaxial Joints, 45 allow limited-to-moderate motion; and diarthrotic
joints allow a great deal of motion.
Atlas of Bony Landmarks and Muscle Attachment
Generally, a correlation exists between the struc-
Sites on Bones, 48
tural and functional classifications of joints. Fibrous
Upper Extremity, 48 joints are usually classified as synarthrotic because
Axial Body, 60 they allow very little motion; cartilaginous joints are
Lower Extremity, 74 usually classified as amphiarthrotic because they allow
a limited-to-moderate amount of motion; and syno-
vial joints are usually classified as diarthrotic because
they allow a great deal of motion.
THE SKELETON
Types of Synovial Joints
The skeletal system is composed of approximately 206 Diarthrotic synovial joints can be subdivided based on
bones and can be divided into bones of the axial body the number of axes around which they permit motion
and bones of the appendicular body. Figure 2-1 is an to occur. The four categories are (1) uniaxial, (2) biaxial,
anterior view of the full skeleton. Figure 2-2 is a pos- (3) triaxial, and (4) nonaxial. These categories can be
terior view. further subdivided based on the shapes of the bones
of the joint.
JOINTS Uniaxial Joints
There are two types of synovial uniaxial joints:
Wherever two or more bones come together, in other
(1) hinge and (2) pivot. Hinge joints act similar to the
words, join, a joint is formed.
hinge of a door. One surface is concave and the other
is shaped similar to a spool. Flexion and extension are
Structural Classification of Joints allowed in the sagittal plane around a mediolateral
Structurally, the definition of a joint is having the two axis. The humeroulnar (elbow) joint is a classic exam-
(or more) bones united by a soft tissue. There are three ple of a hinge joint (Figure 2-4 on page 44).
structural classifications of joints: (1) fibrous, (2) car- The pivot joint is another type of synovial uni-
tilaginous, and (3) synovial (Figure 2-3 on page 44). axial joint. A pivot joint allows only rotation (pivot)
Fibrous joints are united by dense fibrous fascial tissue, motions in the transverse plane around a vertical axis.
cartilaginous joints are united by fibrocartilage, and The atlantoaxial joint of the spine is a classic example
synovial joints are united by a thin fibrous capsule that of a uniaxial pivot joint (Figure 2-5 on page 45).
41
Skull (cranium)
Mandible
2
Cervical vertebrae
Clavicle
Sternum
Scapula
Rib cage
Humerus
Thoracic vertebrae
Lumbar vertebrae
Radius
Sacrum
Ulna
Pelvic bone
Carpals
Metacarpals
Phalanges
Femur
Patella
Fibula
Tibia
Tarsals
Metatarsals
Phalanges
FIGURE 2-1 Full skeleton—anterior view. Green, Axial skeleton; cream, appendicular skeleton.
Chapter 2 The Skeletal System 43
Skull (cranium)
Mandible 2
Clavicle Cervical vertebrae
Scapula
Thoracic vertebrae
Humerus
Radius Rib cage

Carpals
Metacarpals
Ulna
Phalanges
Lumbar vertebrae
Sacrum Pelvic bone
Coccyx
Femur
Fibula
Tibia
Tarsals
Metatarsals
Phalanges
FIGURE 2-2 Full skeleton—posterior view. Green, Axial skeleton; cream, appendicular skeleton.
A
Humerus
Fat pad Fibrous capsule
Distal humerus Synovial

membrane
Synovial
Articular cartilage cavity
Olecranon
processof ulna
Body of Body of
B pubic bone pubic bone Symphysis pubis C
FIGURE 2-3 Structurally, there are three types of joints: A, Fibrous. B, Cartilaginous. C, Synovial.
Biaxial Joints
There are two types of synovial biaxial joints: (1) con-
dyloid and (2) saddle. A condyloid joint has one bone
whose surface is concave, and the other bone’s surface
is convex. The convex surface of one bone fits into the
concave surface of the other. Flexion and extension are
allowed within the sagittal plane around a mediolat-
eral axis, and abduction and adduction are allowed
within the frontal plane around an anteroposterior
axis. The metacarpophalangeal joint of the hand is an
example of a condyloid joint (Figure 2-6).
The other type of synovial biaxial joint is the saddle
joint. Both bones of a saddle joint have a convex and
concave shape. The convexity of one bone fits into
FIGURE 2-4 The humeroulnar joint of the elbow is an example the concavity of the other and vice versa. Flexion and
of a synovial, uniaxial hinge joint. It allows flexion and extension extension are allowed in one plane, and abduction and
within the sagittal plane around a mediolateral axis. adduction are allowed in a second plane. Interestingly,
a saddle joint also allows medial rotation and lateral
rotation to occur in the third plane; therefore some
might consider a saddle joint to be triaxial. However,
because these rotation actions cannot be actively iso-
lated, a saddle joint is still considered to be biaxial.
The carpometacarpal joint of the thumb is a classic
example of a saddle joint (Figure 2-7).
FIGURE 2-5 The atlantoaxial (C1-C2) joint of the spine between the atlas and axis is an example of
a synovial, uniaxial pivot joint. It allows right and left rotations within the transverse plane around a
vertical axis.
A B
FIGURE 2-6 The metacarpophalangeal joint of the hand is an example of a synovial, biaxial
condyloid joint. It allows flexion and extension in the sagittal joint around a mediolateral axis (A)
and abduction and adduction in the frontal plane around an anteroposterior axis (B).
Triaxial Joints Nonaxial Joints

There is only one major type of synovial triaxial joint: Synovial nonaxial joints permit motion within a plane,
ball-and-socket. As its name implies, one bone is but the motion is a linear gliding motion and not a
shaped like a ball and fits into the socket shape of the circular (axial) motion around an axis. The surfaces of
other bone. A ball-and-socket joint allows the follow- nonaxial joints are usually flat or curved. Intercarpal
ing motions: flexion and extension in the sagittal plane joints between individual carpal bones of the wrist are
around a mediolateral axis; abduction and adduction examples of nonaxial joints (Figure 2-9).
in the frontal plane around an anteroposterior axis;
and medial rotation and lateral rotation in the trans-
verse plane around a vertical axis. The hip joint is a
classic example of a ball-and-socket joint (Figure 2-8).
A B
FIGURE 2-7 The carpometacarpal joint of the thumb is an example of a synovial, biaxial saddle
joint. It allows flexion and extension (A); and abduction and adduction (B). It also allows medial and
lateral rotation around a third axis; however, these motions cannot be actively isolated. They must
be coupled with flexion and extension, respectively. (Adapted from Neumann DA: Kinesiology of the
musculoskeletal system: foundations for physical rehabilitation, ed 2, St Louis, 2010, Mosby.)
A B
FIGURE 2-8 The hip joint between the head of the femur and the acetabulum of the pelvic bone is
an example of a synovial, triaxial ball-and-socket joint. It allows flexion and extension in the sagittal
plane around a mediolateral axis (A), abduction and adduction in the frontal plane around an
anteroposterior axis (B), and medial rotation and lateral rotation in the transverse plane around a
vertical axis (C).
FIGURE 2-9 An intercarpal joint of the wrist is an example of a synovial, nonaxial joint. Linear
gliding motion is allowed within a plane, but this motion does not occur around an axis;
consequently, it is nonaxial.
ATLAS OF BONY LANDMARKS AND MUSCLE ATTACHMENT SITES ON BONES

Upper Extremity
2 PROXIMAL
Acromion process
Coracoid process
Clavicle
Supraglenoid tubercle
Superior facet
Glenohumeral joint
Greater tubercle
Bicipital groove
Scapula
Lesser tubercle Subscapular fossa
Infraglenoid
tubercle
L M
A E
T Deltoid tuberosity
Lateral border D
E I
R A
A L
L
Humerus
Shaft
Elbow joint
Coronoid process
Radius
Ulna
Radial tuberosity Ulnar tuberosity
DISTAL
FIGURE 2-10 Anterior view of the bones and bony landmarks of the right scapula/arm.
PROXIMAL
Biceps brachii (long head) Deltoid Clavicle
Trapezius Pectoralis minor

2
Subscapularis
Omohyoid
Supraspinatus
Greater tubercle
Coracobrachialis
Bicipital groove and Biceps brachii
(short head)
Lesser tubercle Serratus anterior
Pectoralis major Triceps

brachii
(long head) Subscapularis
Latissimus dorsi
Teres major
Scapula
Deltoid
L Humerus
M
A E
T D
E I
R Coracobrachialis A
A L
L
Brachialis
Brachioradialis
Pronator teres (humeral head [via common flexor tendon])
Common flexor tendon:

Extensor carpi radialis longus - xor carpi radialis brevis
- !%& #"(&
- *#%%$( "%&
- *#%'#%(!&($% &
Common extensor tendon:
-*'"&#%%pi radialis
Flexor pollicis longus (humeral head)
brevis
-*'"&#%'#%(! Flexor digitorum superficialis (ulnar head)
-*'"&#%'!"!
-*'"&#%%$( "%& Pronator teres (ulnar head)
Brachialis Flexor pollicis longus (ulnar head)
Radius Supinator
Supinator Ulna Origin (proximal attachment)

Biceps brachii Insertion (distal attachment)
DISTAL
FIGURE 2-11 Anterior view of muscle attachment sites on the right scapula/arm.
PROXIMAL
Acromion process
Supraspinous fossa
Clavicle
2 Supraglenoid tubercle
Superior facet
Middle facet
Spine of scapula Greater tubercle
Scapula
Inferior facet
Glenohumeral joint
Infraglenoid
tubercle
Infraspinous fossa
Deltoid tuberosity
Lateral border
L
M A
E T
D E
I R
A Humerus A
L L
Shaft
Elbow joint
Olecranon process
Radius
Ulna
DISTAL Radial tuberosity
FIGURE 2-12 Posterior view of bones and bony landmarks of the right scapula/arm.
PROXIMAL
Clavicle Trapezius
Deltoid
2
Levator scapulae
Supraspinatus
Supraspinatus
Infraspinatus
Rhomboid minor
Teres minor
Infraspinatus
Triceps
brachii Triceps brachii (lateral head)
(long head)
Rhomboid major Teres minor
Deltoid
M L
Brachialis A
E T
D Teres major
I E
A R
Scapula Humerus A
L L
Latissimus dorsi
Triceps brachii (medial head)
Supinator (humeral head)
Triceps brachii
Anconeus
Common flexor tendon:

*
xor carpi radialis brevis
*#$! &$
Common extensor tendon:
*
(!##"& #$
* (% $!#rpi radialis
*
(!#%!#&$&"#$
brevis
* (% $!#%!#&m
Anconeus * (% $!#%
* (% $!##"& #$
Ulna
Origin (proximal attachment)
Radius
Insertion (distal attachment) DISTAL
FIGURE 2-13 Posterior view of muscle attachment sites on the right scapula/arm.
PROXIMAL
Humerus
2
Lateral supracondylar ridge Medial supracondylar ridge
Lateral epicondyle
Medial epicondyle
Elbow joint
Head
Coronoid process
Radial tuberosity
Supinator crest
Radial shaft
Ulna
Radius
L R M
A U
A E
T L
D D
E Interosseus membrane N
I I
R A
A A
A R
L L
L
Wrist joint
Pisiform
Styloid process
Hook of hamate
Metacarpals 1 through 5
Proximal phalanx of thumb Base of metacarpal

1
4 5
2 3
Base of phalanx
Distal phalanx of thumb
Proximal phalanx of finger
Middle phalanx of finger
Distal phalanx of finger
DISTAL
FIGURE 2-14 Anterior view of bones and bony landmarks of the right forearm.
PROXIMAL
Brachioradialis Brachialis
Pronator teres (humeral head

Extensor carpi radialis longus [via common flexor tendon])
2
Common flexor tendon
( Flexor carpi radialis brevis,
Common extensor tendon: ( Palmaris longus,
( Extensor carpi radialis brevis ( Flexor carpi ulnaris, and
( Extensor digitorum ( Flexor digitorum superficialis
( Extensor digiti minimi
( Extensor carpi ulnaris
Flexor pollicis longus (humeral head)
Brachialis
Flexor digitorum superficialis (ulnar head)
Supinator Pronator teres (ulnar head)
Flexor pollicis longus (ulnar head)

Supinator
Biceps brachii
Flexor digitorum superficialis (radial head)
Flexor digitorum profundus

Pronator teres
L R M
A U
A E
T L
D Flexor pollicis longus D
E N
I I
R Ulna A
A A
A R
L Radius L
L
Pronator quadratus
Pronator quadratus
Brachioradialis
Flexor carpi ulnaris
Abductor pollicis longus

Extensor carpi ulnaris
Flexor pollicis longus
Flexor carpi radialis
Flexor digitorum superficialis
DISTAL Insertion (distal attachment)
FIGURE 2-15 Anterior view of muscle attachment sites on the right forearm.
PROXIMAL
Humerus
2 Medial supracondylar ridge Lateral supracondylar ridge
Lateral epicondyle
Medial epicondyle
Olecranon process
Head
Elbow joint
Radial tuberosity
Supinator crest
Ulna Radial shaft
L
M R
U A
E A
Radius
L T
D D
N Interosseus membrane E
I I
A R
A A
R A
L L L
Wrist joint
Styloid process
Pisiform
Base of metacarpal
1 Proximal phalanx of thumb
5
Base of phalanx 4 3
2
Distal phalanx of thumb
DISTAL
FIGURE 2-16 Posterior view of bones and bony landmarks of the right forearm.
PROXIMAL
Supinator (humeral head) Triceps brachii (medial head)
Triceps brachii Anconeus 2
Flexor carpi ulnaris (humeral head Extensor carpi radialis brevis,

[via common flexor tendon]) Extensor digitorum,
Extensor digiti minimi, and
Anconeus Extensor carpi ulnaris
(common extensor tendon)
Supinator
Flexor digitorum profundus Biceps brachii
Supinator
Flexor carpi ulnaris (ulnar head)
Pronator teres

L
M R
U A
E Extensor carpi ulnaris (ulnar head) Extensor pollicis longus A
L T
D D
N E
I I
A R
A A
R Extensor pollicis brevis A
L Extensor indicis L L
Radius
Ulna
Brachioradialis
Extensor carpi ulnaris Abductor pollicis longus
Extensor pollicis brevis

Extensor carpi radialis brevis
Extensor pollicis longus
Extensor carpi radialis longus

Extensor digiti minimi
Extensor indicis

Extensor digitorum Insertion (distal attachment)
DISTAL
FIGURE 2-17 Posterior view of muscle attachment sites on the right forearm.
PROXIMAL
Scaphoid Capitate Lunate
Scaphoid tubercle Triquetrum

2
Trapezium Pisiform
Tubercle of trapezium Hamate
Trapezoid Hook of hamate
Base of metacarpal
2
3 Metacarpophalangeal
Interphalangeal 4 (MCP) joint
(IP) joint 5
Sesamoid bones Base of phalanx
L R M
A U
A E
T L
D Proximal phalanx D
E N
I of thumb I
R A
A A
A R
L L
L
Distal phalanx
of thumb

Proximal
interphalangeal
(PIP) joint
Distal
Middle phalanx of finger interphalangeal
(DIP) joint
DISTAL
FIGURE 2-18 Palmar view of bones and bony landmarks of the right hand.
PROXIMAL
Abductor pollicis brevis Adductor pollicis
Flexor pollicis brevis Abductor digiti minimi manus

2
Opponens pollicis Flexor carpi ulnaris
Abductor pollicis longus Flexor digiti minimi manus
Opponens pollicis Opponens digiti minimi
Flexor pollicis brevis Flexor carpi ulnaris
Flexor carpi Opponens digiti minimi

Abductor radialis
pollicis brevis Flexor digiti
minimi manus
Flexor Palmar Abductor digiti

pollicis brevis interossei minimi manus
L R M
A U
A Adductor pollicis E
T L
D D
E N
I I
R A
A A
A R
L Flexor pollicis L
L longus
Flexor
Palmar interossei Adductor Palmar digitorum
pollicis interossei superficialis
Flexor
digitorum
profundus
Flexor Flexor
digitorum digitorum
superficialis superficialis
Flexor
digitorum profundus
Insertion (distal attachment)

DISTAL
FIGURE 2-19 Palmar view of muscle attachment sites on the right hand.
PROXIMAL
Lunate Capitate
Scaphoid
2 Pisiform
Triquetrum
Trapezium
Hamate Trapezoid
Base of metacarpal
Proximal phalanx
1 of thumb
3 2
5 4
Metacarpophalangeal
(MCP) joint Interphalangeal
(IP) joint
Base of phalanx L
M Sesamoid bone R
U A
E A
L T
D D
N E
I I
A R
A A
R A
L L L
Proximal Distal phalanx
interphalangeal of thumb
(PIP) joint
Distal
interphalangeal
(DIP) joint
DISTAL
FIGURE 2-20 Dorsal view of bones and bony landmarks of the right hand.
PROXIMAL
2
Dorsal interossei manus
Extensor pollicis
brevis
Adductor pollicis L
M R
U A
E A
L T
D D
N E
I I
A R
A A
R A
L L L
Extensor digiti
minimi Extensor
pollicis longus
Dorsal Extensor indicis

interossei
manus
Extensor digitorum
Extensor digitorum Origin (proximal attachment)

DISTAL
FIGURE 2-21 Dorsal view of muscle attachment sites on the right hand.
Axial Body
SUPERIOR
Basilar part of occiput Occiput
Temporal bone
2
Mastoid process of temporal bone
Anterior arch of atlas
Styloid process of temporal bone
Atlas (C1)
Greater cornu C2 Axis (C2)
Body
Hyoid bone
Vertebral body
Lamina
Thyroid cartilage Vertebral transverse process (TP)

L L
Sternoclavicular (SC) joint First rib
A Posterior tubercle A
T T
E Acromioclavicular (AC) joint C7 Anterior tubercle E
R R
A A
T1
L L
Clavicle Costal cartilage Medial border Acromion process

of rib 1 of scapula of scapula
Glenohumeral Manubrium Superior border
(GH) joint Scapula of sternum of scapula
INFERIOR
FIGURE 2-22 Anterior view of bones and bony landmarks of the neck.
Lateral
pterygoid
Medial
pterygoid
Mylohyoid line
Mylohyoid
line Origin (proximal attachment)
Inferior Digastric Geniohyoid Digastric
mental spine fossa fossa Insertion (distal attachment)
FIGURE 2-23 FIGURE 2-24

Stylohyoid Geniohyoid
Mylohyoid
Close-Up
of Hyoid Bone 2
Sternohyoid
SUPERIOR
Thyrohyoid Omohyoid Longus capitis Rectus capitis anterior
Rectus
Sternocleidomastoid
capitis
lateralis
Digastric
Rectus
Stylohyoid capitis anterior
MS Rectus
capitis lateralis
AS
Longus colli
MS
Thyrohyoid
AS
Insertion (distal attachment) Longus capitis
MS
Sternothyroid
L PS L
A M A
MS E
T AS D T
E PS I E
R A R
A MS L A
L PS L
Trapezius Longus colli
MS
Omohyoid
PS
MS AS Sternocleidomastoid
INFERIOR
FIGURE 2-25 Anterior view of muscle attachment sites on the neck. AS, Anterior scalene;
MS, middle scalene; PS, posterior scalene.
SUPERIOR
2 Temporal bone
External occipital
protuberance (EOP)
Occiput
Mastoid process
of temporal bone
Superior nuchal line
Mandible
Inferior nuchal line Atlas (C1)
Axis (C2)
Vertebral spinous process (SP) Vertebral transverse process (TP)
Acromioclavicular Clavicle Superior angle

L C7 L
(AC) joint of scapula
A A
T T1 First rib T
E E
R R
A A
L L
Acromion process
of scapula
Spine of scapula T5
Scapula
Tubercle at root Medial border Root of spine Fourth rib

of spine of scapula of scapula of scapula
INFERIOR
FIGURE 2-26 Posterior view of bones and bony landmarks of the neck.
Obliquus capitis superior

Obliquus
capitis
Close-up
inferior
of Transverse
Process 2
of Atlas (C1)
Levator
Splenius cervicis scapulae
SUPERIOR
Trapezius Occipitofrontalis
Semispinalis (of
transversospinalis group)
Rectus capitis posterior minor
Splenius capitis
Posterior auricular
Sternocleidomastoid
Rectus capitis posterior major Longissimus

(of erector spinae group)
Rectus capitis
Obliquus capitis inferior posterior major
L L
A Splenius cervicis A
T Levator scapulae T
E E
Trapezius
R R
A A
L Splenius capitis L
Trapezius Sternocleidomastoid
Splenius cervicis
Levator scapulae
INFERIOR Insertion (distal attachment)
FIGURE 2-27 Posterior view of muscle attachment sites on the neck.

SUPERIOR
C7 Posterior tubercle of cervical transverse process

Clavicle First rib
2 Anterior tubercle of cervical transverse process
T1
Humerus
Coracoid process
Medial lip of
bicipital groove
Scapula
Lateral lip of
bicipital groove
Medial border
Inferior angle Sternum
Intercostal space Xiphoid process of sternum
M
E
Costal cartilage D
I
L A L
A L A
T T12
T
E E
R L1 R
A Twelfth rib
A
L L
Sacroiliac joint Vertebral transverse process (TP)
Iliac crest L5
Sacrum
Pelvic bone
Pubic crest Pubis

Pubic tubercle Pubic symphysis joint
INFERIOR
FIGURE 2-28 Anterior view of bones and bony landmarks of the trunk.
SUPERIOR
Pectoralis minor Subclavius External intercostal
Internal intercostal
2
Latissimus dorsi Pectoralis

major Internal intercostal
Pectoralis major External intercostal
Serratus anterior
Subcostales
Pectoralis minor
Serratus anterior External M

abdominal E
oblique D Diaphragm
L I L
A A A
T L T
E E
R Latissimus dorsi R
A Rectus A
L abdominis L
Internal abdominal oblique
Subcostales
Transversus Intertransversarii
abdominus Diaphragm
Quadratus lumborum
External abdominal oblique
Erector spinae group
Rectus abdominis

INFERIOR
FIGURE 2-29 Anterior view of muscle attachment sites on the trunk.

SUPERIOR
Posterior tubercle of cervical transverse process

2 Spine of scapula Clavicle
C7
T1 First rib
Tubercle
Root of spine of scapula
Medial border Angle
Scapula
Intercostal space
M
Inferior angle E
D
I
A
L
L L
A A
T T12 Twelfth rib T
E E
R R
A L1 A
L L
Vertebral transverse process (TP)
Inferior articular process (facet)
Lamina Superior articular process (facet)
Mamillary process
Vertebral spinous process (SP)
Iliac crest L5
Ilium
Posterior superior
iliac spine (PSIS) Sacroiliac joint
Pelvic bone Medial sacral crest
Sacrum Lateral sacral crest
Ischium Pubis Pubic symphysis joint
INFERIOR
FIGURE 2-30 Posterior view of bones and bony landmarks of the trunk.
j i l h f
f m m e
e
c
T3
t f l f
b o 2
u o
SUPERIOR c
T4 n
g n
T5
j
i
h
T11
m o o
n
T12 n
t
e
a j l e
d k a q
k d r
L1 f
i l
j
g i
INFERIOR
Latissimus dorsi
Ilium
a. Latissimus dorsi Sacrum

b. Rhomboids major and minor
c. Serratus posterior superior
d. Serratus posterior inferior Iliocostalis, longissimus,
e. Iliocostalis and multifidus
f. Longissimus
Sacrotuberous ligament
g. Spinalis
h. Semispinalis
i. Multifidus Rectus abdominis
j. Rotatores
k. Quadratus lumborum
l. Intertransversarii
m. Levatores costarum Pubis
n. External intercostals
o. Internal intercostals Ischium
p. Rectus abdominis
q. External abdominal oblique
r. Internal abdominal oblique
s. Transversus abdominis
(not seen)
t. Trapezius Origin (proximal attachment)
u. Splenius capitis and cervicis
FIGURE 2-31 Posterior view of muscle attachment sites on the trunk.

SUPERIOR
Frontal bone
2
Superciliary arch
Temporal fossa
Nasal bone (within dotted line)
Lesser wing
of sphenoid
Greater wing
Sphenoid bone
of sphenoid
Temporal bone
L Lacrimal bone L
A A
T T
E E
R Zygomatic bone R
A A
L Infraorbital foramen L
Zygomaticomaxillary Canine fossa
suture Incisive fossa
Maxilla Ramus
Incisive fossa
Alveolar process
Angle
Mental foramen
Oblique line
Alveolar process
Mental tubercle
Mandible Symphysis Menti
INFERIOR
FIGURE 2-32 Anterior view of bones and bony landmarks of the head.
SUPERIOR
Corrugator supercilii
Orbicularis oculi Temporalis
Levator palpebrae
superioris
Orbicularis oculi
L (lacrimal part) L
A A
T Levator labii T
E superioris E
R alaeque nasi R
A A
Zygomaticus major
L L
Levator labii superioris
Levator anguli oris Zygomaticus minor
Masseter
Nasalis
Depressor septi nasi
Masseter
Temporalis
Buccinator
Depressor anguli oris
Platysma
Origin (proximal attachment) Depressor labii inferioris
Insertion (distal attachment) Mentalis
INFERIOR
FIGURE 2-33 Anterior view of muscle attachment sites on the head.

SUPERIOR
Temporomandibular joint (TMJ) Parietal bone Temporal fossa (within dotted line)
Temporal bone Frontal bone

2
Sphenoid bone
Greater wing
Superciliary arch
Lacrimal bone
P Nasal bone
A
O N
S T
T E
E R
R I
I O
O R
R
Frontal process
Highest
nuchal line Zygomatic bone
Occipital bone Canine fossa
Mastoid process Maxilla
Zygomatic arch Incisive fossa

Neck
Alveolar
Zygomaticotemporal suture process
Coronoid process
Incisive fossa
Ramus
Zygomaticomaxillary suture
Angle Mandible Mental tubercle
Oblique line Mental foramen

INFERIOR
FIGURE 2-34 Lateral view of bones and bony landmarks of the head.
SUPERIOR
2
Temporalis Zygomaticus major
Orbicularis oculi
Levator labii
P superioris A
O alaeque nasi N
S T
T E
E R
R I
Orbicularis oculi
I (lacrimal part) O
O R
R Levator labii
superioris
Zygomaticus minor
Levator anguli oris

Occipitofrontalis
Posterior auricular
Nasalis
Sternocleidomastoid
Depressor
septi nasi
Masseter
Lateral pterygoid
Temporalis
Mentalis
Masseter
Origin (proximal attachment) Buccinator

Insertion (distal attachment) Depressor anguli oris Platysma Depressor labii inferioris
INFERIOR
FIGURE 2-35 Lateral view of muscle attachment sites on the head.

ANTERIOR
Maxilla Incisive fossa
Palatine bone Zygomaticomaxillary

2
Zygomatic bone
Tuberosity of maxilla
Frontal bone Greater wing of sphenoid
Zygomaticotemporal
Zygomatic arch suture
Medial pterygoid plate

of pterygoid process
Parietal bone
Lateral pterygoid plate
of pterygoid process
Sphenoid bone
L L
A A
T T
E E
R R
A A
L L
Styloid process
Temporal bone
Mastoid process
Mastoid notch
Parietal bone
Jugular process
Foramen magnum
Occipital bone Highest nuchal line
POSTERIOR
FIGURE 2-36 Inferior view of bones and bony landmarks of the head.
ANTERIOR
2
Medial pterygoid
Lateral pterygoid
Longus capitis
Masseter
Rectus capitis anterior
Temporalis
Sternocleidomastoid
L L
A A
T Digastric T
E E
R R
A Rectus A
L Stylohyoid
capitis lateralis L
Longissimus (of erector

spinae group)
Splenius capitis
Rectus capitis posterior major
Origin (proximal attachment) Trapezius

Semispinalis
Insertion (distal attachment) Occipitofrontalis (of transversospinalis group)
POSTERIOR
FIGURE 2-37 Inferior view of muscle attachment sites on the head.

Lower Extremity
PROXIMAL
2 Vertebral transverse process (TP)

L1
Sacral ala
Intervertebral disc
Iliac crest Vertebral body
Iliac fossa L5
Internal ilium Sacrum Iliopectineal eminence
Ilium
Apex of sacrum
Anterior superior iliac spine (ASIS)

Coccyx
Anterior inferior iliac spine (AIIS) Pectineal line of pubis on superior

ramus of pubis
Hip joint
Body of pubis
L Inferior ramus of pubis M

A Greater trochanter
E
T
Obturator foramen D
E
Lesser trochanter I
R
Ischial ramus A
A L
L
Ischium Ischial tuberosity
Femur
Patella
Lateral tibial condyle Knee joint
Medial tibial condyle

Head of fibula
Fibula Tibia
DISTAL
FIGURE 2-38 Anterior view of bones and bony landmarks of the right pelvis and thigh.
PROXIMAL
T12
Psoas minor
2
Psoas major
Ilium
L5
Iliacus
Piriformis
Sartorius Sacrum
Psoas minor
&'%emoris
Pectineus
Superior gemellus, obturator internus, Adductor longus
and inferior gemellus
Adductor brevis
Piriformis
Gracilis
Gluteus minimus
L Obturator externus
M
A
Vastus lateralis Adductor magnus E
T D
E
Quadratus femoris I
R A
A L
L Psoas major and iliacus
Vastus medialis
Vastus intermedius
Femur
Articularis genus
Adductor magnus
Tensor fasciae latae and gluteus

maximus via Iliotibial band Patella
Biceps femoris
Sartorius
Quadriceps femoris Gracilis

*&'%emoris
*Vastus lateralis Semitendinosus
*Vastus intermedius
*Vastus medialis Origin (proximal attachment)
Fibula Tibia Insertion (distal attachment)
DISTAL
FIGURE 2-39 Anterior view of muscle attachment sites on the right pelvis and thigh.
PROXIMAL
Vertebral transverse process (TP) Iliac crest
Posterior gluteal line
Sacrum Anterior gluteal line
2
Ilium
External ilium
Greater sciatic foramen

Apex of sacrum
Inferior gluteal line
Anterior superior iliac spine (ASIS)
Coccyx Anterior inferior iliac spine (AIIS)
Ischial spine
Pectineal line of pubis on
superior ramus of pubis Hip joint
Body Greater trochanter

Pubis
Inferior ramus
Trochanteric fossa
Obturator foramen
Intertrochanteric crest
Ramus of ischium
Ischium Lesser trochanter

L
M Ischial tuberosity A
E T
D Pectineal line of femur Gluteal tuberosity E
I R
A A
L L
Medial lip
Linea aspera
Lateral lip
Femur
Medial supracondylar line
Adductor tubercle Lateral supracondylar line
Knee joint
Head of fibula
Tibia Fibula
DISTAL
FIGURE 2-40 Posterior view of bones and bony landmarks of the right pelvis and thigh.
PROXIMAL
Ilium
2
Gluteus medius
Gluteus maximus
Tensor fasciae latae
Sacrum
Gluteus minimus
Superior gemellus
Sartorius
Inferior gemellus Rectus femoris
Obturator externus
Quadratus femoris
Gluteus medius
Obturator internus
Quadratus femoris
Biceps femoris and semitendinosus
Adductor magnus Vastus lateralis
Semimembranosus
L
M Psoas major and iliacus A
E T
D Pectineus
Gluteus maximus
E
I R
A A
L Adductor brevis
Vastus intermedius
L
Biceps femoris (short head)
Adductor longus
Adductor magnus
Vastus medialis
Femur
Adductor magnus
Plantaris
Gastrocnemius (medial head) Gastrocnemius (lateral head)
Popliteus
Semimembranosus
Biceps femoris
Popliteus

Tibia
Fibula Insertion (distal attachment)
DISTAL
FIGURE 2-41 Posterior view of muscle attachment sites on the right pelvis and thigh.
PROXIMAL
Femur
Lateral supracondylar line
2
Lateral condyle Medial condyle
Knee joint
Lateral condyle
Head of fibula
Fibula
Tibia
Interosseus membrane
L M
A E
T D
E I
R A
A L
L
Ankle joint
Medial malleolus
Lateral malleolus Talus
Calcaneus Navicular
Cuboid 1st cuneiform

2nd cuneiform
Base of metatarsal
3rd cuneiform
5 4 3 2 1
Proximal phalanx of toe
Metatarsals 1 through 5
Middle phalanx of toe
Proximal phalanx of big toe
Distal phalanx of toe
Distal phalanx of big toe
DISTAL
FIGURE 2-42 Anterior view of bones and bony landmarks of the right leg.
PROXIMAL
Femur
Gluteus maximus and tensor fasciae latae

via iliotibial band
Sartorius
Biceps femoris
Quadriceps femoris
Gracilis
Fibularis longus Semitendinosus
Tibialis anterior
Tibia
L M
A E
T D
E I
R A
A Fibularis brevis Extensor hallucis longus L
L
Extensor digitorum longus
Fibularis tertius
Fibula
Fibularis brevis
Fibularis tertius
Extensor digitorum longus Extensor hallucis longus

DISTAL
FIGURE 2-43 Anterior view of muscle attachment sites on the right leg.
PROXIMAL
Femur Lateral supracondylar line
2
Medial condyle
Lateral condyle
Knee joint
Lateral condyle
Head of fibula
Soleal line
Tibia Fibula L
M A
E T
D E
I R
A Interosseus membrane A
L L
Ankle joint
Calcaneus
Medial malleolus
Lateral malleolus
Talus Cuboid
Navicular
3rd cuneiform Base of metatarsal
2nd cuneiform
1st cuneiform 2 3 4 5
1 Proximal phalanx of toe
Proximal phalanx of big toe Distal phalanx of toe
DISTAL
FIGURE 2-44 Posterior view of bones and bony landmarks of the right leg.
PROXIMAL
Femur
Plantaris
Gastrocnemius (lateral head) 2

Gastrocnemius (medial head)
Popliteus
Semimembranosus Biceps femoris
Popliteus
Soleus
Tibialis posterior
Flexor digitorum longus L

M A
E T
D E
I Flexor hallucis longus R
A A
L L
Tibia
Plantaris Fibularis brevis
Fibula
Gastrocnemius and soleus
(via calcaneal tendon [Achilles tendon])
Tibialis posterior
Tibialis anterior
Fibularis longus
Flexor hallucis longus Insertion (distal attachment)
Flexor digitorum longus

DISTAL
FIGURE 2-45 Posterior view of muscle attachment sites on the right leg.
PROXIMAL
2
Calcaneus
Talus
Navicular
Cuboid
1st cuneiform
L
2nd cuneiform M
A E
T
Metatarsals 1 through 5 D
E 3rd cuneiform
I
R
Base of metatarsal A
A L
L
5
4
3
Metatarsophalangeal 2
(MTP) joint 1
Proximal interphalangeal
(PIP) joint
Base of phalanx
Distal interphalangeal
(DIP) joint Interphalangeal (IP) joint
Distal phalanx of toe Distal phalanx of big toe
DISTAL
FIGURE 2-46 Dorsal view of bones and bony landmarks of the right foot.
PROXIMAL
Extensor digitorum brevis

and extensor hallucis brevis
Fibularis brevis
L M
A Fibularis tertius E
T D
E I
R A
A L
L Dorsal interossei pedis
Dorsal interossei pedis
Extensor hallucis brevis

Extensor hallucis longus

Insertion (distal attachment) Extensor digitorum longus
DISTAL
FIGURE 2-47 Dorsal view of muscle attachment sites on the right foot.
PROXIMAL
2
Calcaneal tuberosity
Calcaneus
Talus
Navicular
Cuboid
3rd cuneiform
2nd cuneiform
1st cuneiform L
M A
E T
D 5 E
I Base of metatarsal 4 R
A 3
Metatarsophalangeal (MCP) A
L 2
joint L
1
Sesamoid bones
Proximal interphalangeal (PIP) joint
Base of phalanx
Distal interphalangeal (DIP) joint
Interphalangeal (IP) joint
Distal phalanx of toe
DISTAL
FIGURE 2-48 Plantar view of bones and bony landmarks of the right foot.
PROXIMAL
Gastrocnemius and soleus
via calcaneal (Achilles) tendon
Plantaris
Flexor digitorum brevis 2
Abductor hallucis Abductor digiti minimi pedis
Quadratus plantae
Flexor hallucis brevis
Tibialis posterior
Tibialis posterior
Flexor digiti minimi pedis
Fibularis longus
L
M Plantar interossei
Tibialis anterior A
E T
D E
I R
A A
L Adductor hallucis
L
Flexor hallucis brevis Dorsal interossei pedis
Abductor digiti minimi pedis
Plantar interossei
Abductor hallucis Flexor digitorum brevis
Flexor hallucis brevis Flexor digitorum longus

and adductor hallucis
Flexor digitorum brevis
Flexor hallucis longus

Flexor digitorum longus Origin (proximal attachment)
DISTAL Insertion (distal attachment)
FIGURE 2-49 Plantar view of muscle attachment sites on the right foot.
REVIEW QUESTIONS
Circle or fill in the correct answer for each of the following questions. More study resources are provided on the Evolve
2 website at http://evolve.elsevier.com/Muscolino/knowthebody.
1. What are the three major structural classifications 6. Which of the following is a triaxial joint?
of joints? a. Saddle
b. Condyloid
________________________________________________ c. Pivot
d. Ball-and-socket
________________________________________________
7. If a joint is biaxial, in how many planes can motion
________________________________________________ be actively isolated?
a. 1
2. What are the three major functional classifications b. 2
of joints? c. 3
d. 0
________________________________________________
8. Approximately how many bones are in the human
________________________________________________ body?
a. 53
________________________________________________ b. 145
c. 206
3. Based on axial motion, what are the four major d. 312
subdivisions of synovial joints?
9. Which of the following types of joints only allows
________________________________________________ rotation motions?
a. Pivot
________________________________________________ b. Saddle
c. Ball-and-socket
________________________________________________ d. Hinge
________________________________________________ 10. Fibrous joints are generally considered to be
4. Which of the following is a uniaxial joint? __________________________________?

a. Condyloid a. Cartilaginous
b. Saddle b. Synovial
c. Pivot c. Synarthrotic
d. Ball-and-socket d. Amphiarthrotic
5. Which of the following is a biaxial joint?

a. Saddle
b. Hinge
c. Pivot
d. Ball-and-socket
CHAPTER
How Muscles Function
3
CHAPTER OUTLINE Realizing that this pulling force is equal on both of its
attachments is also important. A muscle does not and
Muscles Create Pulling Forces, 87 cannot choose to pull on one of its attachments and
What Is a Muscle Contraction? 88 not the other. In effect, a muscle is nothing more than
Concentric Contraction, 88 a simple “pulling machine.” When ordered to con-
tract by the nervous system, it pulls on its attachments;
Reverse Actions, 89 when not ordered to contract, it relaxes and does not
Naming a Muscle’s Attachments: pull (Box 3-1).
Origin and Insertion versus Attachments, 91 Determining whether there is a cognate (i.e., a
Eccentric Contractions, 91 similar term in lay English) is usually extremely help-
Isometric Contractions, 92 ful when confronted with a new kinesiology term.
This helps us understand the new kinesiology term
Roles of Muscles, 92 intuitively instead of having to memorize its mean-
Sliding Filament Mechanism, 93 ing. When it comes to the study of muscle function,
Muscle Fiber Architecture, 94 the operative word is contract because that is what
Learning Muscles, 94 muscles do. However, in this case, it can be counter-
productive to try to understand muscle contraction
Five-Step Approach to Learning Muscles, 96 by relating it to how the term contract is defined in
Figuring Out a Muscle’s Actions English. In English, the word “contract” means “to
(Step 3 in Detail), 96 shorten.” This leads many students to assume that
Question 1—What Joint Does the when a muscle contracts, it shortens. This is not nec-
Muscle Cross? 97 essarily true, and making this assumption can limit
Questions 2 and 3—Where Does the our ability to truly grasp how the muscular system
Muscle Cross the Joint? How Does the functions. In fact, most muscle contractions do not
Muscle Cross the Joint? 97 result in the muscle shortening; to examine the mus-
cular system in this way is to overlook much of how
Functional Group Approach to Learning the muscular system functions.
Muscles, 97
Visual and Kinesthetic Exercise for Learning a
Muscle’s Actions, 98
BOX 3-1
Rubber Band Exercise, 98
To call a muscle nothing more than a simple “pulling

machine” does not lessen the amazing and awe-
inspiring complexity of movement patterns that the
MUSCLES CREATE PULLING FORCES muscular system produces. Any one muscle is a simple
machine that pulls. However, when different aspects of
The essence of muscle function is that muscles create
various muscles are co-ordered to contract in concert
pulling forces. It is as simple as that. When a muscle with each other and in temporal sequence with one
contracts, it attempts to pull in toward its center. This another, the sum of many “simple” pulling forces results
action results in a pulling force being placed on its in an amazingly fluid and complex array of movement
attachments. If this pulling force is sufficiently strong, patterns. The director of this symphony who coordinates
the muscle will succeed in shortening and will move these pulling forces is the nervous system.
one or both of the body parts to which it is attached.
87
WHAT IS A MUSCLE CONTRACTION? role in musculoskeletal function. When a muscle’s

function is described, it is usually stated in terms of its
When a muscle contracts, it attempts to shorten. joint actions, which are its shortening contractions. For
Whether or not it succeeds in shortening is based this reason, the tendency is to focus on the shortening
on the strength of its contraction compared with the contraction of a muscle and overlook the importance
resistance force it encounters that opposes its shorten- of its contraction when it does not shorten.
3 ing. For a muscle to shorten, it must move one or both
of its attachments. Therefore the resistance to shorten-
ing is usually the weight of the body parts to which the Concentric Contraction
muscle is attached. Let’s look at the brachialis muscle Let’s first look at what happens when a muscle contracts
that attaches from the humerus in the arm to the ulna and does shorten. A shortening contraction of a muscle
in the forearm (Figure 3-1). is called a concentric contraction. The word “concentric”
For the brachialis to contract and shorten, it must literally means “with center.” In other words, when a
move the forearm toward the arm or move the arm concentric contraction occurs, the muscle moves toward
toward the forearm or both. The resistance to mov- its center. As we have said, for a muscle to contract and
ing the forearm is the weight of the forearm plus the shorten, it must move at least one of its attachments.
weight of the hand that must move (go along for the Let’s explore the idea of concentric contraction by look-
ride) with the forearm. The resistance to moving the ing at a “typical” muscle (Figure 3-2).
arm is the weight of the arm plus the weight of much A muscle attaches to two bones and, in doing so,
of the upper part of the body that must move (go along crosses the joint that is located between them (Box
for the ride) when the arm moves toward the fore- 3-2). Let’s call one of the attachments A and the other
arm. Consequently, for the brachialis to contract and attachment B. When the muscle contracts, it creates
shorten, it must generate a force that is greater than
the weight of the forearm (and hand) or the arm (and
upper body). Because the forearm and hand weigh less BOX 3-2
than the arm and upper body, when the brachialis con-
tracts and shortens, the forearm usually moves, not the A typical muscle attaches to two bones and crosses
arm. Thus the minimum force that the brachialis must the joint between them. However, some muscles
generate if it is to contract and shorten is the weight of have attachments to more than two bones and some
its lighter attachment—the forearm. muscles cross more than two joints. To help understand
However, even if the brachialis contracts with the underlying concept of a muscle’s contraction, we
insufficient strength to shorten, it is important to will use a typical muscle that attaches to two bones and
understand that it is still exerting a pulling force on its crosses one joint for our examples.
attachments. This pulling force can play an important
FIGURE 3-1 The brachialis muscle attaches from the humerus in FIGURE 3-2 A “typical” muscle is shown. It attaches to bone A
the arm to the ulna in the forearm. For the brachialis to contract and bone B and crosses the joint that is located between them.
and shorten, it must move the forearm toward the arm or move
the arm toward the forearm or both.
Chapter 3 How Muscles Function 89
a pulling force on both bones. If this pulling force joint actions are learned, they are usually presented and
is strong enough, then a concentric contraction can demonstrated with the proximal attachment fixed and
occur in three possible ways: (1) the muscle can either the distal attachment mobile. These actions are termed
succeed in pulling bone A toward bone B, (2) it can the standard mover actions of the muscle.
pull bone B toward bone A, or (3) it can pull both
bones A and B toward each other (Figure 3-3). The
bone that moves is described as the mobile attachment, Reverse Actions 3
and the bone that does not move is described as the Although the more common and typically thought of
fixed attachment. For a concentric contraction to occur, muscle action (the standard action) is one in which
at least one of the attachments must be mobile and the proximal attachment stays fixed and the distal
move. Regardless of which attachment moves, when a attachment moves, this is not always the case. In fact,
muscle contracts and does generate sufficient force to often it is not. Let’s look at a concentric contraction
move one or both of its attachments, it is the mover of of the brachialis muscle across the elbow joint. When
the joint action that is occurring and called the mover the brachialis contracts, it would most likely move the
or agonist. By definition, when a mover muscle con- distal attachment toward the proximal attachment,
tracts, it contracts concentrically. moving the forearm and hand toward the arm (Figure
If we now explore concentric contraction a little 3-4, A). However, if the hand holds onto an immova-
further and ask which attachment will be the mobile ble object such as a pull-up bar, then because the hand
one that does the moving, the answer will be the is fixed, the forearm is also fixed and cannot move
one that offers the least resistance to moving. That unless the pull-up bar is ripped off the wall. Therefore
attachment will usually be the lighter attachment. the arm will now offer less resistance to moving than
When we are looking at muscles on the extremities of the forearm, and if the brachialis contracts with suf-
the body, the lighter attachment is usually the distal ficient force to move the arm (and the weight of the
one. In the upper extremity, the hand is lighter than trunk that must move with it), the arm will be moved
the forearm, the forearm is lighter than the arm, and toward the forearm and the person will do a pull-up
the arm is lighter than the shoulder girdle/trunk. In the (Figure 3-4, B). When the proximal attachment moves
lower extremity, the foot is lighter than the leg, the leg toward the distal attachment instead of the distal one
is lighter than the thigh, and the thigh is lighter than moving toward the proximal one, it is called a reverse
the pelvis. Furthermore, as we have stated, for the more mover action. In this scenario, therefore, flexing the
proximal attachment to move, the core of the body forearm toward the arm at the elbow joint is the typi-
must usually move with it, which adds even more cally thought of standard action, and flexing the arm
weight and resistance to moving. Consequently, when toward the forearm at the elbow joint is the reverse
a muscle concentrically contracts, it usually moves its action. For every standard action of a muscle, a reverse
distal attachment. For this reason, when a muscle’s action is always theoretically possible.
B
B Mobile
Fixed Mobile
B
Mobile
Mobile
A
A B Fixed C
FIGURE 3-3 A muscle can concentrically contract and cause motion in one of three ways. By
naming the muscle’s attachments A and B, we can describe these three scenarios. A, Bone A
moves toward bone B. B, Bone B moves toward bone A. C, Both bones A and B move toward
each other.
FIGURE 3-5 When we stand up from a seated position, the quad-

riceps femoris muscles create their reverse mover action, which
is the extension of the thighs at the knee joints; in other words,
extending the more proximal thighs toward the distal legs instead
of extending the more distal legs toward the proximal thighs.
An excellent example of this is when we use our

B quadriceps femoris muscle group to stand from a
seated position (Figure 3-5). We usually think of the
FIGURE 3-4 A, The standard mover action of the brachialis quadriceps femoris group as extending the leg at the
muscle in which the distal forearm moves toward the proximal knee joint. But in this case, it must perform the reverse
arm. B, When the hand is fixed, the reverse mover action action of extending the thigh at the knee joint. As the
occurs; the proximal arm moves toward the distal forearm. thighs extend at the knee joints, the rest of the body
must also be lifted. If you palpate the quadriceps fem-
oris in your anterior thighs as you stand up from a
How often reverse actions occur varies across the seated position, you will easily feel their contraction.
body and is also based on what motions and activities In fact, it is because of this frequent activity of daily
are being performed. In the upper extremity, reverse life that our quadriceps femoris group needs to be
actions usually occur whenever the hand is gripping large and powerful.
an immovable object. A pull-up bar as illustrated In the axial body, we do not use the terms proximal
in Figure 3-4, B, is one example of this. Many other and distal. Usually, standard muscle action moves the
examples in everyday life exist, such as using a banister superior attachment toward the inferior one. This is
when walking up the stairs, someone helping to pull because the upper axial body (head, neck, and upper
you up from a seated to standing position, and a dis- trunk) is both lighter than the lower axial body (lower
abled person using a handicap bar. trunk) and because when we are sitting or standing,
In the lower extremity, reverse actions are extremely our lower body is more fixed and, consequently, more
common because much of the time when we are resistant to moving. Therefore when a muscle of the
standing, seated, or walking, our foot is planted on the axial body moves the lower trunk toward the upper
ground. Unless we are on ice or some other slick sur- trunk, neck, and head, it is a reverse mover action.
face, our foot is at least partially fixed and resistant to These reverse actions happen quite often when we
moving, resulting in our leg moving toward the foot. are lying down, for example, when moving in bed, or
Similarly, with the distal end fixed, the thigh would when doing floor exercises.
have to move toward the leg and the pelvis would have When students first study muscle system function
to move toward the thigh. and the specific actions of muscles, it is extremely
important not to develop a too rigid mindset and

look only at a muscle as moving its distal (or superior)
attachment when it concentrically contracts. Remember,
a reverse mover action is always theoretically possible.
Although some rarely occur, others occur frequently
and play an integral part of everyday movement patterns
and activities. In this text, when a muscle is discussed, 3
both standard and reverse actions are presented.
NAMING A MUSCLE’S ATTACHMENTS:

ORIGIN AND INSERTION VERSUS
ATTACHMENTS
The classic method to name a muscle’s attachments
is to describe one attachment as the origin and the
other as the insertion. Although the exact definitions
have varied, the origin is usually defined as the more
fixed attachment and the insertion as the more mobile
attachment. Because the proximal attachment is usu- FIGURE 3-6 The right brachialis muscle eccentrically contracts
to slow gravity's force of extension of the forearm at the elbow
ally the more fixed attachment and the distal attach-
joint, allowing the glass to be safely lowered to the table top.
ment is usually the more mobile attachment, some
medical dictionaries even define the origin as the
more proximal attachment and the insertion as the the student must learn that a muscle has two
more distal attachment. attachments; either one can potentially move, and
In recent years, the use of the terms origin and inser- what determines which one actually does move in any
tion has been decreasing in favor. Perhaps the reason particular scenario depends on its relative resistance to
is that teaching students who are first learning mus- being moved.
cles that one attachment of the muscle is usually fixed
tends to promote the idea that it is always fixed. This
belief can lead to less flexibility in how the students ECCENTRIC CONTRACTIONS
view muscular function because they tend to ignore
the reverse actions of muscles wherein the insertion We have already discussed concentric contractions.
stays fixed and the origin moves. Given how often They occur when a muscle contracts with a force that is
these reverse actions actually occur can handicap the greater than an attachment’s resistance force to moving.
student as he or she begins to use and apply muscle Therefore the muscle moves the attachment and suc-
knowledge clinically with clients. ceeds in shortening. As previously stated, a muscle does
For these reasons, naming a muscle’s attachments not always succeed in shortening when it contracts.
by simply describing their locations is gaining favor. If a muscle contracts, attempting to pull in toward
After all, if the origin can also be defined as the proxi- its center, but the resistance force is greater than the
mal attachment and the insertion can also be defined muscle’s contraction force, not only will the muscle
as the distal attachment, why not skip use of the terms not succeed in shortening, but the muscle’s attachment
origin and insertion entirely and simply learn the will actually be pulled farther away from the center of
names of the attachments as proximal and distal? Or, the muscle. A lengthening of the muscle as it contracts
if the muscle is running superiorly and inferiorly or will be the result. A lengthening contraction is defined
medially and laterally, simply naming the attachments as an eccentric contraction.
using these locational terms is not only simpler, but it Eccentric contractions happen most often when
also has the advantage of pointing out to the student a muscle is working against gravity. For example, if
the fiber direction of the muscle. This helps the stu- I am holding an object and want to lower it down
dent see the muscle’s line of pull, which is the most to a tabletop, I can let gravity bring my forearm and
crucial step in figuring out its actions. hand down. However, if the object is fragile, I need
At present, both naming systems are used in the to lower it slowly so that it does not crash down onto
field of kinesiology, therefore being comfortable and the table and break. This requires me to contract
conversant with both is important. For this reason, this musculature that opposes gravity so that the object
text uses both origin/insertion (O and I) terminology can be lowered slowly and safely (Figure 3-6). In this
and attachment terminology. Most importantly, example, the purpose of the muscle contraction is not
to beat gravity and raise the object; rather, its purpose of the muscle’s contraction is less than the resist-
is to lose to gravity but to do so slowly so that the ance force. An isometric contraction occurs when
effect of the force of gravity is slowed and the object is the force of the muscle’s contraction is equal to the
lowered slowly. Therefore the purpose of an eccentric resistance force. Because the two forces are equal, the
contraction is to slow or restrain a joint action that is muscle is neither able to win and shorten nor lose
caused by another force, usually gravity. Because the and lengthen. Instead, it stays the same length as it
3 muscle that eccentrically contracts opposes the joint contracts. This is defined as an isometric contraction.
action movement that is occurring, it is called the In fact, the term isometric literally means same length.
antagonist. By definition, when an antagonist muscle If the muscle stays the same length, then its attach-
contracts, it contracts eccentrically (Box 3-3). ments do not move. The function of an isometri-
cally contracting muscle can be critically important
Note: Eccentric contractions are sometimes referred to as
because it fixes or, in other words, stabilizes its bony
negative contractions.
attachment (Figure 3-7).
ISOMETRIC CONTRACTIONS
ROLES OF MUSCLES
A concentric contraction occurs when the force of
the muscle’s contraction is greater than the resistance As we have seen, muscle function can be viewed very
force; an eccentric contraction occurs when the force simply: muscles contract and create pulling forces.
However, muscles can contract concentrically and
shorten as movers, contract eccentrically and lengthen
BOX 3-3 as antagonists, or contract isometrically and stay the
same length as stabilizers. All too often, students who
first learn muscle function focus only on the muscle’s
By definition, when a mover muscle contracts and
standard mover concentric contractions. For a deeper
shortens, it contracts concentrically; and when an
understanding of muscle function, we need to under-
antagonist muscle contracts and lengthens, it contracts
eccentrically. This does not mean that every muscle that stand and appreciate all types of contractions and all
is shortening is concentrically contracting or that every roles that a muscle can play in our movement patterns.
muscle that is lengthening is eccentrically contracting. A Only this deeper understanding will allow for the criti-
muscle can be relaxed as it shortens or lengthens. cal thinking necessary for clinical application when it
comes to the assessment and treatment of clients.
Force of musculature
Force of gravity
A B
FIGURE 3-7 A, The person’s deltoid muscle isometrically contracts with a force that is equal to
the force of gravity so that the person’s arm does not move. B, The musculature of the person
arm wrestling is isometrically contracting because the resistance force from the opponent is
exactly equal to the muscle’s contraction force. Therefore no movement occurs.
SLIDING FILAMENT MECHANISM it is called a tendon. If it is broad and flat, it is called

an aponeurosis. The major purpose of the tendon/
To truly understand the bigger picture of concentric, aponeurosis is to transmit the pulling force of the
eccentric, and isometric contractions, examining the muscle belly to its bony attachment (Box 3-4).
actual mechanism that defines muscle contraction is If we look more closely at an individual muscle
helpful. This mechanism occurs on a microscopic level fiber, we see that it is filled with structures called myo-
and is known as the sliding filament mechanism. fibrils. Myofibrils run longitudinally within the muscle 3
A muscle is made up of thousands of muscle cells, fiber and are composed of filaments (see Figure 3-8).
also known as muscle fibers. Within a muscle, these fib- These filaments are arranged into structures called sar-
ers are bundled together into groups called fascicles. comeres. The term sarcomere literally means “unit of
A muscle also contains numerous layers of fibrous muscle.” To truly understand how a muscle functions,
fascia that are identical to each other in structure but understanding how a sarcomere functions is necessary.
are given different names based on their location.
Endomysium (plural: endomysia) surrounds each indi-
vidual muscle fiber; perimysium (plural: perimysia) BOX 3-4
surrounds each fascicle; and epimysium surrounds the
entire muscle (Figure 3-8). The endomysia, perimysia, Additional layers of fibrous fascia also envelop and
and epimysium continue beyond each end of the mus- surround groups of muscles within a region of the body.
cle to create the fibrous tissue attachment of the muscle These layers are often called intermuscular septa.
onto the bone. If this attachment is cordlike in shape,
Tendon
Fibrous fascia
Bone
Axon of motor neuron
Muscle
Fascicle
Epimysium
Blood vessel
Perimysium
Muscle fibers
Endomysium
Muscle fiber
Myofibrils
Myofibril
Filaments
FIGURE 3-8 Cross sections of a muscle. A muscle is composed of fascicles, which are bundles
of fibers. The fibers themselves are filled with myofibrils, which are composed of filaments.
Fibrous fascial sheaths called endomysia, perimysia, and epimysium surround the fibers,
fascicles, and entire muscle, respectively.
Sarcomeres are composed of thin and thick fila- enough muscle fibers shorten, then the muscle itself
ments. The thin filaments are actin and are arranged on will shorten, pulling one or both of its attachments in
both sides of the sarcomere and attach to the Z-lines, toward the center, causing motion of the body. This is
which are the borders of the sarcomere. The thick fila- how a concentric contraction occurs.
ment is a myosin filament and is located in the center When a muscle’s contraction is said to create a pull-
and contains projections called heads. When a stim- ing force toward its center, that pulling force is the sum
3 ulus from the nervous system is sent to the muscle, of the bending forces of all the myosin heads. If the
binding sites on the actin filaments become exposed sum of these forces is greater than the resistance to
and the myosin heads attach onto them, creating shortening, then the actin filaments will be pulled in
cross-bridges. The myosin heads then attempt to bend toward the center of the sarcomere and a concentric
in toward the center of the sarcomere, creating a pull- contraction occurs. If the sum of these forces is less
ing force on the actin filaments. If the pulling force is than the resistance to shortening, then the actin fila-
sufficiently strong, the actin filaments will be pulled ments will be pulled away from the center of the sar-
in toward the center of the sarcomere, sliding along comere and an eccentric contraction occurs. If the sum
the myosin filament, hence the name sliding filament of the forces of the myosin heads is equal to the resis-
mechanism. This will cause the Z-lines to be pulled tance force, then the actin filaments will not move and
in toward the center and the sarcomere will shorten an isometric contraction occurs. Therefore the defi-
(Figure 3-9). nition of muscle contraction is having myosin heads
Whatever happens to one sarcomere happens to creating cross-bridges and pulling on actin filaments.
all the sarcomeres of all the myofibrils of the muscle
fiber. If we extrapolate this concept, we see that if all
the sarcomeres of a myofibril shorten, then the myo- MUSCLE FIBER ARCHITECTURE
fibril itself will shorten. If all the myofibrils of a mus-
cle fiber shorten, then the muscle fiber will shorten. If Not all muscles have their fibers arranged in the
same manner. There are two major architectural types
of muscle fiber arrangement: (1) longitudinal and
Sarcomere
(2) pennate. A longitudinal muscle has its fibers run-
ning along the length of the muscle. A pennate mus-
Z-line Z-line cle has its fibers running obliquely to the length of the
muscle. The major types of longitudinal muscles are
demonstrated in Figure 3-10. The major types of pen-
nate muscles are demonstrated in Figure 3-11.
Actin filaments Myosin heads Myosin filaments LEARNING MUSCLES

Relaxed Q Essentially, when learning about muscles, two
major aspects must be learned: (1) the attachments
of the muscle and (2) the actions of the muscle.
Q Generally speaking, the attachments of a muscle
must be memorized. However, times exist when
clues are given about the attachments of a muscle
Cross-bridges by the muscle’s name.
Concentrically contracting Q For example, the name coracobrachialis tells us
that the coracobrachialis muscle has one attach-

ment on the coracoid process of the scapula and
the other attachment on the brachium (i.e., the
humerus).
Q Similarly, the name zygomaticus major tells us
Fully concentrically contracted

that this muscle attaches onto the zygomatic
bone (and is bigger than another muscle called
FIGURE 3-9 A sarcomere is composed of actin and myosin the zygomaticus minor).
filaments. When the nervous system orders a muscle fiber to Q Unlike muscle attachments, muscle actions do not
contract, myosin heads attach to actin filaments, attempting to have to be memorized. Instead, by understanding
pull them in toward the center of the sarcomere. If the pulling the simple concept that a muscle pulls at its attach-
force is strong enough, the actin filaments will move and the ments to move a body part, the action or actions of
sarcomere will shorten.
a muscle can be reasoned out.
A B C
D E
FIGURE 3-10 Various architectural types of longitudinal muscles. A, Brachialis demonstrates a

fusiform-shaped (also known as spindle-shaped) muscle. B, Sartorius demonstrates a strap
muscle. C, Pronator quadratus demonstrates a rectangular-shaped muscle. D, Rhomboid
muscles demonstrate rhomboidal-shaped muscles. E, Pectoralis major demonstrates a
triangular-shaped (also known as fan-shaped) muscle.
A B C
FIGURE 3-11 The three architectural types of pennate muscles. A, Vastus lateralis is a unipen-
nate muscle. (Note: Central tendon is not visible in the anterior view.) B, Rectus femoris is a
bipennate muscle. C, Deltoid is a multipennate muscle.
Five-Step Approach to Learning Q Step 5: Now examine the relationship of this mus-
cle to other muscles (and other soft-tissue struc-
Muscles tures) of the body. Look at the following:
When first confronted with having to study and learn Q Is this muscle superficial or deep?
about a muscle, the following five-step approach is Q What other muscles (and other soft tissue struc-
recommended: tures) are located near this muscle?
Q Step 1: Look at the name of the muscle to see
whether it gives you any “free information” that Figuring Out a Muscle’s Actions (Step 3 in Detail)
saves you from having to memorize attachments or Q Once you have a general familiarity with a muscle’s
actions of the muscle. location on the body, it is time to begin the pro-
Q Step 2: Learn the general location of the muscle cess of reasoning out the actions of the muscle. The
well enough to be able to visualize the muscle on most important thing that you must look at is the
the body. At this point, you need only know it well following:
enough to know the following: Q The direction of the muscle fibers relative to the
Q What joint it crosses joint that it crosses
Q Where it crosses the joint (e.g., anteriorly, Q By doing this, you can see the following:
medially) Q The line of pull of the muscle relative to the joint
Q How it crosses the joint (i.e., the direction Q This line of pull determines the actions of the mus-
in which its fibers are running—vertically or cle (i.e., how the contraction of the muscle causes
horizontally) the body parts to move at that joint).
Q Step 3: Use this general knowledge of the muscle’s Q The best approach is to ask the following three
location (Step 2) to figure out the actions of the questions:
muscle. 1. What joint does the muscle cross?
Q Step 4: Go back and learn (memorize, if necessary) 2. Where does the muscle cross the joint?
the specific attachments of the muscle. 3. How does the muscle cross the joint?
Question 1—What Joint Does the Muscle Cross? head crosses the GH joint with its fibers running
Q The first question to ask and answer in figuring out horizontally; therefore it adducts the arm at the GH
the action(s) of a muscle is to simply know what joint because it pulls the arm from lateral to medial
joint it crosses. in the frontal plane, which is termed adduction.
Q The following rule applies: If a muscle crosses a Q With a muscle that has a horizontal direction to
joint, it can have an action at that joint. (Note: This, its fibers, another factor must be considered when
of course, assumes that the joint is healthy and allows looking at how this muscle crosses the joint; that is, 3
movement to occur.) whether the muscle attaches to the first place on the
Q For example, if we look at the coracobrachialis (see bone that it reaches or whether the muscle wraps
Figure 6-26), knowing that it crosses the shoulder around the bone before attaching to it. Muscles
(glenohumeral [GH]) joint tells us that it must that run horizontally (in the transverse plane) and
have an action at the GH joint. wrap around the bone before attaching to it create
Q We may not know what the exact action of the a rotation action when they contract and pull on
coracobrachialis is yet, but at least we now know at the attachment.
what joint it has its actions. Q For example, the sternocostal head of the pectora-
Q To figure out exactly what these actions are, we lis major does not attach to the first point on the
need to look at questions 2 and 3. humerus that it reaches. Rather, it continues to
wrap around the shaft of the humerus to attach
Note: It is worth pointing out that the converse of the rule onto the lateral lip of the bicipital groove of the
about a muscle having the ability to create movement (i.e., humerus. When the sternocostal head pulls, it
an action) at a joint that it crosses is also generally true. In medially rotates the arm at the GH joint (in addi-
other words, if a muscle does not cross a joint, it cannot tion to its other actions).
have an action at that joint. (Exceptions to this rule exist.) Q In essence, by asking the three questions of Step 3
of the five-step approach to learning muscles (What
Questions 2 and 3—Where Does the Muscle Cross joint does a muscle cross? Where does the muscle
the Joint? How Does the Muscle Cross the Joint? cross the joint? How does the muscle cross the
Q The above two questions must be examined joint?), we are trying to determine the direction of
together. the muscle fibers relative to the joint. Determining
Q The where of a muscle crossing a joint is whether it this will reveal the line of pull of the muscle, rela-
crosses the joint anteriorly, posteriorly, medially, or tive to the joint; that will give us the actions of the
laterally. muscle—saving us the trouble of having to memo-
Q Placing a muscle into one of these broad groups is rize this information!
helpful because the following general rules apply:
Q Muscles that cross a joint anteriorly will usually
Functional Group Approach
flex a body part at that joint, and muscles that
cross a joint posteriorly will usually extend a to Learning Muscles
body part at that joint. Once the five-step approach to learning muscles has
Q Muscles that cross a joint laterally will usually been used a few times and learned, it is extremely
abduct or laterally flex a body part at that joint, helpful to begin to transition to the functional group
and muscles that cross a joint medially will usu- approach to learning muscles. This approach places
ally adduct a body part at that joint. emphasis on seeing that muscles can be placed into a
Q The how of a muscle crossing a joint is whether it functional group, based on their common joint action.
crosses the joint with its fibers running vertically or For example, if the biceps brachii has been studied and
horizontally, which is also important. it is seen that it crosses the elbow joint anteriorly and
Q To illustrate this idea, we will look at the pectora- flexes it, then it is easier to see and learn that the bra-
lis major muscle (see Figure 6-12). The pectora- chialis also flexes the elbow joint because it also crosses
lis major has two parts: (1) clavicular head and it anteriorly. In fact, all muscles that cross the elbow
(2) sternocostal head. The where of these two heads joint anteriorly belong to the functional group of
of the pectoralis major crossing the GH joint is the elbow joint flexors. Similarly, all muscles that cross the
same (i.e., they both cross the GH joint anteriorly). elbow joint posteriorly belong to the functional group
However, the how of these two heads crossing the of elbow joint extensors.
GH joint is very different. The clavicular head crosses Applying the functional group approach to the GH
the GH joint with its fibers running primarily ver- joint, it is seen that all muscles that cross it anteriorly
tically; therefore it flexes the arm at the GH joint with a vertical fiber direction (or at least a vertical com-
because it pulls the arm upward in the sagittal plane, ponent to their fiber direction) flex it. All muscles that
which is termed flexion. However, the sternocostal cross it posteriorly with a vertical fiber direction extend
it. All muscles that cross it laterally, abduct it; and all
muscles that cross it medially adduct it. Functional BOX 3-5
groups of medial and lateral rotators are not as segre-
gated location-wise; but, with closer inspection, it is When performing the rubber band exercise, it is
seen that all medial rotators of the GH joint wrap in extremely important that the attachment of the rubber
the same direction and all lateral rotators wrap in the band that you are pulling on is pulled exactly toward
3 other direction. the other attachment and in no other direction. In other
words, your line of pull should be exactly the same
as the line of pull of the muscle (which is essentially
Visual and Kinesthetic Exercise determined by the direction of the fibers of the muscle).
When performing the rubber band exercise, the
for Learning a Muscle’s Actions attachment of the muscle that you are pulling on would
Rubber Band Exercise be the mobile attachment in that scenario; the end
that you do not move is the fixed attachment in that
An excellent method for learning the actions of a mus-
scenario. Further, by doing this exercise twice (i.e., by
cle is to place a large, colorful rubber band (or large, then repeating it by reversing which attachment you
colorful shoelace or string) on your body or on the hold fixed and which one you pull on and move), you are
body of a partner in the same place that the muscle simulating the standard mover action and the reverse
you are studying is located. mover action of the muscle.
Q Hold one end of the rubber band at one of the
attachment sites of the muscle, and hold the other
end of the rubber band at the other attachment site is an excellent exercise both to see the actions of
of the muscle. a muscle and to kinesthetically experience the
Q Make sure that you have the rubber band running actions of a muscle.
or oriented in the same direction as the direction Q This exercise can be used to learn all muscle actions
of the fibers of the muscle. If it is not uncomfort- and can be especially helpful for determining
able, you may even loop or tie the rubber band (or actions that may be a little more difficult to visual-
shoelace) around the body parts that are the attach- ize, such as rotation actions.
ments of the muscle.
Note: The use of a large, colorful rubber band is more help-
Q Once you have the rubber band in place, pull one
ful than a shoelace or string because when you stretch out
of the ends of the rubber band toward the other
a rubber band and place it in the location where a muscle
attachment of the rubber band to observe the action
would be, the natural elasticity of a rubber band creates a
that the rubber band/muscle has on that body part’s
pull on the attachment sites that nicely simulates the pull of
attachment. Once done, return the attachment of
a muscle on its attachments when it contracts.
the rubber band to where it began and repeat this
exercise for the other end of the rubber band to see Q If you can, you should work with a partner to per-
the action that the rubber band/muscle has on the form this exercise. Have your partner hold one of
other attachment of the muscle (Box 3-5). the “attachments” of the rubber band while you
Q By placing the rubber band on your body or on hold the other “attachment.” This leaves one of
your partner’s body, you are simulating the direc- your hands free to pull the rubber band attachment
tion of the muscle’s fibers relative to the joint that sites (one at a time) toward the center.
it crosses.
Q By pulling either end of the rubber band toward
Note of caution: If you are using a rubber band, be care-
ful that you do not accidentally let go and have the rubber
the center, you are simulating the line of pull of
band hit you or your partner. For this reason, it would be
the muscle relative to the joint that it crosses.
preferable to use a shoelace or string instead of a rubber
The resultant movements that occur are the
band when working near the face.
mover actions that the muscle would have. This
REVIEW QUESTIONS
website at http://evolve.elsevier.com/Muscolino/knowthebody.
1. What are the two types of filaments in a myofibril? 6. What kind of contraction occurs when a muscle 3
contracts and the attachments of the muscle move
________________________________________________ farther apart?
a. Shortening
________________________________________________ b. Concentric
c. Eccentric
2. What are the three major fascial coverings of d. Isometric
muscle tissue?
7. What body part can move when the elbow joint
________________________________________________ flexes?
a. Forearm
________________________________________________ b. Arm
c. Choices a and b
________________________________________________ d. None of the above
3. What three questions should be asked when trying 8. Which of the following terms best describes
to figure out the action(s) of a muscle? extension of the thigh at the knee joint?
a. Eccentric contraction
________________________________________________ b. Reverse action
c. Negative contraction
________________________________________________ d. Standard action
________________________________________________ 9. What type of muscle contraction tends to occur

when gravity is the mover force?
4. Which of the following best describes the essence a. Concentric
of muscle function? b. Eccentric
a. Muscles shorten. c. Shortening
b. Muscles move bones. d. Isometric
c. Muscles stabilize.
d. Muscles create pulling forces. 10. Which of the following is true regarding the origin
of a muscle?
5. What kind of contraction occurs when a muscle a. It is distal.
contracts and the attachments of the muscle move b. It always stays fixed.
closer together? c. It always moves.
a. Isometric d. It can move toward the insertion.
b. Concentric
c. Eccentric
d. None of the above
CHAPTER
How to Palpate
4
CHAPTER OUTLINE
What Is Palpation? 102 Palpation Guidelines—cont'd
Objectives of Palpation: Location and Guideline 10: When Appropriate, Use
Assessment, 102 Coupled Actions, 109
When Do We Palpate? 103 Guideline 11: When Appropriate, Use
How to Learn Palpation, 103 Reciprocal Inhibition, 110
Palpation Guidelines, 104 Guideline 12: Use Appropriate
The Science of Muscle Palpation, 104 Pressure, 111
Guideline 1: Know the Attachments Guideline 13: For Deep Palpations,
of the Target Muscle, 104 Sink Slowly into the Tissue and Have
the Client Breathe, 111
Guideline 2: Know the Actions of the
Target Muscle, 104 Guideline 14: Use Muscles as
Landmarks, 112
Beginning the Art of Muscle Palpation, 105
Guideline 15: Relax and Passively
Guideline 3: Choose the Best Action
Slacken the Target Muscle When
of the Target Muscle to Make it
Palpating its Bony Attachment, 112
Contract, 105
Guideline 16: Close Your Eyes When You
Perfecting the Art of Muscle Palpation, 105
Palpate, 113
Guideline 4: Add Resistance to the
Guideline 17: Construct a Mental Picture
Contraction of the Target Muscle, 106
of the Client’s Anatomy Under the Skin
Guideline 5: Look Before You Palpate, 107 as You Palpate, 113
Guideline 6: First Find and Palpate Guideline 18: If a Client Is Ticklish, Have
the Target Muscle in the Easiest Place the Client Place a Hand Over Your
Possible, 107 Palpating Hand, 113
Guideline 7: Strum Perpendicularly Guideline 19: Keep Fingernails Short and
Across the Target Muscle, 107 Smooth, 113
Guideline 8: Use Baby Steps to Follow Guideline 20: Use the Optimal Palpation
the Target Muscle, 108 Position, 113
Guideline 9: Alternately Contract and Apply Guidelines and Be Creative, 114
Relax the Target Muscle, 109
Summary List of Muscle Palpation
Guidelines, 114
T his chapter explains the science and art of palpa-

tion. In other words, it explains how to palpate.
After an introduction to palpation, 20 guidelines of
art of muscle palpation. In all, these guidelines can help
increase palpatory literacy of the muscles of the body.
Before beginning the muscle palpation protocols pre-
muscle palpation are discussed. The two most basic sented in Chapters 6 through 11, reading this chapter
guidelines described as the science of muscle palpation in its entirety is recommended.
are (1) know the attachments and (2) know the actions Video segments showing how to palpate individual
of the target muscle being palpated. The additional muscles are located on Evolve at http://evolve.elsevier.
18 guidelines describe how to begin and perfect the com/muscolino/knowthebody.
101
WHAT IS PALPATION? OBJECTIVES OF PALPATION:

LOCATION AND ASSESSMENT
Palpation may be defined in many ways. The word
palpation, itself, derives from the Latin palpatio, There are two main objectives when palpating.
which means “to touch.” However, defining palpa- Objective 1 is locating the target structure. Objective 2
tion as simply touching is too simplistic because is assessing the target structure.
more is involved. Inherent in the term palpation is The first objective, and indeed perhaps the major
not just touching but also the act of sensing or per- objective of the novice therapist, is to locate the tar-
4 ceiving what is being touched. In this context, palpa- get structure being palpated. This feat is not easy to
tion involves more than just the fingers and hands. achieve. It is one thing to simply touch the tissues
Palpation also involves the mind. Successful palpa- of the client. It is an entirely different matter to be
tion requires us to feel with our brains, as well as with able to touch the tissues and discern the target struc-
our fingers. When palpating, the therapist should be ture from all the adjacent tissues. This ability requires
focused with a mindful intent; in other words, the the therapist to locate all borders of the structure—
therapist must be in his or her hands. All of the thera- superiorly, inferiorly, medially, laterally, and even
pist’s correlated knowledge of anatomy must be inte- superficially and deep. If the structure is immediately
grated into the sensations that the therapist’s fingers superficial to the skin, then this feat may not be very
are picking up from the client’s body and sending to difficult. Indeed, the olecranon process of the ulna
his or her brain. The therapist’s mind must be open or a well-developed deltoid muscle may be visually
to the sensations that are coming in from the client, obvious and located without even touching the cli-
yet, at the same time, interpret these sensations with ent’s body. However, if the target structure is deeper
an informed mind (Figure 4-1). Incorporating mind- in the client’s body, then locating the structure may
ful intent into examination and treatment sessions present a great challenge.
creates mindful touch. As basic as palpation for the purpose of determin-
ing location may seem, it is a supremely important
first objective because it follows that if a structure can-
not be accurately located and discerned from adjacent
tissues, then it cannot be accurately assessed. Once the
target structure is located, then the process of assess-
ment can begin. Assessment requires the interpreta-
tion of the sensations that the palpating fingers pick
up from the target structure. It involves becoming
aware of the qualities of the target structure—its size,
shape, and other characteristics. Is it soft? Is it swollen?
Is it tense or hard? All of these factors must be consid-
ered when assessing the health of the target structure.
It is worthy of note that as high-tech diagnostic and
assessment equipment continues to be developed in
Western medicine, palpating hands remain the pri-
mary assessment tool of a manual therapist. Indeed,
for a manual therapist, palpation—the act of gather-
ing information through touch—lies at the very heart
of assessment. Armed with both an accurate location
and an accurate assessment of the health of the target
structure through careful palpation, the therapist can
develop an effective treatment plan that can be confi-
dently carried out.
Note: As crucial as palpation is to assessment, it is still only
one piece of a successful assessment picture. Visual obser-
FIGURE 4-1 Palpation is as much an act of the mind as it is vation, history, findings from specific orthopedic assess-
of the palpating fingers. Sensory stimuli entering through the ment procedures, and the client’s response to treatment
therapist’s hands must be correlated with a knowledge base of approaches must also be considered when developing an
anatomy. accurate client assessment.
Chapter 4 How to Palpate 103
WHEN DO WE PALPATE? sensing the quality of the tissue and its response to our
pressure. This new information might guide us to alter
Always. Whenever we are contacting the client, we or fine-tune our treatment for the client. Thus while we
should be palpating. This is true not only during the work, we continue to assess, gathering information that
assessment phase of the session but also during the guides the pace, depth, or direction of the next strokes.
treatment phase. Too many therapists view palpation Ideally, no stroke should be carried out in a cookbook
and treatment as separate entities that are compart- manner, performed as if on autopilot. Treatment is a
mentalized within a session. A therapist often spends dynamic process. How the middle and end of each
the first part of the session palpating and gathering stroke are performed should be determined from the 4
sensory input for the sake of assessment and evalu- response of the client to that stroke as we perform it.
ation. Using the information gathered during this This is the essence of mindful touch, having a fluid
palpation assessment stage, a treatment plan is deter- interplay between assessment and treatment; assess-
mined and the therapist then spends the rest of the ment informs treatment and treatment informs assess-
session implementing the treatment plan by output- ment, creating optimal therapeutic care for the client.
ting pressure into the client’s tissues. Rigidly seen in
this manner, palpation and treatment might each be
viewed as a one-way street: palpation is sensory infor- HOW TO LEARN PALPATION
mation in from the client, and treatment is motor pres-
sure out to the client. The problem with this view is A long-standing exercise to learn palpation is to take
that we can also glean valuable assessment informa- a hair and place it under a page of a textbook without
tion while we are treating. seeing where you placed it. With your eyes closed, pal-
Treatment should be a two-way street that involves pate for the hair until you find it and can trace its shape
not simply motor pressure out to the tissues of the cli- under the page. Once found, now replace the hair, this
ent but also continued sensory information in from time under two pages, and palpate to locate and trace
the tissues of the client’s body (Figure 4-2). While we it. Continue to increase the number of pages placed
are exerting pressure on the client’s tissue, we are also over the hair until you cannot find it. If this exercise
is repeated, the number of pages under which you can
locate and trace the hair will gradually increase, and
your sensitivity will improve.
Even more important than performing palpation
exercises with textbooks, applying palpation directly
to the client is imperative. When your hands are on
your fellow students in school or on your clients if you
are in professional practice, constantly try to feel for
the structures about which you have learned in your
anatomy, physiology, and kinesiology classes. As your
hands are moving on the client’s skin, close your eyes
so that you block out extraneous sensory stimuli and
try to picture all the subcutaneous structures over
which your hands are passing. The better you can pic-
ture an underlying structure, the better you will be
able to feel it with your palpating hands and with your
mind. Once felt, you can focus on locating its precise
location and assessing its tissue quality.
Given that the foundation of all manual skills rests
on our palpatory ability to read the clues and signs
that a client’s body offers, the better we hone this skill,
the greater palpatory literacy we gain. Perfecting our
palpatory literacy is a work in progress—an endless
FIGURE 4-2 This figure illustrates the idea that palpation should journey. The more we polish and perfect this skill, the
be done whenever the therapist contacts the client, even when greater our therapeutic potential becomes, bringing
administering treatment strokes. As motor pressure is applied to greater benefit to our clients. However, written chapters
the client’s tissues, the hands should be picking up all palpatory
can only provide guidelines and a framework for how to
sensory signals that help with assessment at the same time.
palpate. Ultimately, palpation is a kinesthetic skill and,
as such, can only be learned by kinesthetic means. In is to know the attachments of the target muscle. For
other words, “palpation cannot be learned by reading example, if we know that the deltoid is attached to the
or listening; it can only be learned by palpation.”* lateral clavicle, acromion process, spine of the scapula,
and deltoid tuberosity of the humerus, then we need
simply to place our palpating hand there to feel it
(Figure 4-3).
PALPATION GUIDELINES
The following 20 guidelines are provided for success- Guideline 2: Know the Actions of the Target Muscle
4 ful muscle palpation. The first two guidelines make up Sometimes, even if a target muscle is superficial, it can
the science of muscle palpation. The remaining guide- be difficult to discern the borders of the muscle. If the
lines begin and perfect the art of muscle palpation. target muscle is deep to another muscle, it can be that
much harder to palpate and discern from more super-
The Science of Muscle Palpation ficial and other nearby muscles. To better discern the
target muscle from all adjacent musculature and other
Guideline 1: Know the Attachments of the Target soft tissues, asking the client to contract the target mus-
Muscle cle by performing one or more of its actions is help-
When a target muscle is superficial, it is usually not ful. If the target muscle contracts, it will become pal-
difficult to palpate. If we know where it is located, we pably harder. Assuming that all the adjacent muscles
can simply place our hands there and feel for it. Unless stay relaxed and therefore palpably soft, the difference
a great deal of subcutaneous fat is in that region of the in tissue texture between the hard target muscle and
body, apart from the client’s skin, we will be directly on the soft adjacent muscles will be clear. This difference
the muscle. Therefore the first step of muscle palpation will allow an accurate determination of the location of
the target muscle. Therefore the second step of muscle
*Frymann VM: Palpation, its study in the workshop, AAO palpation is to know the actions of the target muscle
Yearbook, 16-31:1963. (Figure 4-4).
FIGURE 4-4 The precise location of the deltoid is more easily

palpated if the deltoid is contracted. In this figure, the client is
FIGURE 4-3 The deltoid is a superficial muscle and can be asked to abduct the arm at the shoulder against the force of
palpated by simply placing our palpating hand on the muscle gravity. When a muscle contracts, it becomes palpably harder
between its attachments. Therefore knowing the attachments and is easier to distinguish from the adjacent soft tissues.
of the target muscle is the first necessary step when looking to Therefore knowing the actions of the target muscle is the
palpate it. second necessary step when looking to palpate a muscle.
Guidelines 1 and 2 of muscle palpation involve

Note: There are times when the client is not able to perform
knowing the “science” of the target muscle; in other
only the action that is being asked by the therapist; this is
words, knowing the attachments and actions of the
especially true with motions of the toes, because we do not
muscle that were learned when the muscles of the
usually develop the coordination necessary to isolate certain
body were first learned. Armed with this knowledge,
toe actions. In addition, if for any reason, a client contracts
the majority of muscle palpations can be reasoned out
a muscle during a palpation protocol that he or she is not
instead of memorized. Using the attachments and
supposed to, preventing the body part from moving does
actions to palpate a target muscle can be thought of as
not help the palpation. It is the contraction of any muscle
the science of muscle palpation. 4
other than the target muscle that is undesirable, not the
movement of a client’s body part.
Beginning the Art of Muscle Palpation

Guideline 3: Choose the Best Action of the Target Perfecting the Art of Muscle Palpation
Muscle to Make it Contract Knowing the attachments and actions of the target
Applying knowledge of the attachments and actions muscle are the first two steps of learning the science of
of a target muscle to palpate it is a solid foundation muscle palpation. Determining which joint action to
for palpatory literacy. However, effective palpation ask the client to perform is the beginning of learning
requires not only that the target muscle contracts, the art of muscle palpation. However, perfecting the
but it also requires that an isolated contraction of art of muscle palpation involves the knowledge and
the target muscle occurs. This means that the target
muscle needs to be the only muscle that contracts,
and all muscles near the target muscle must remain
relaxed. Unfortunately, because adjacent muscles
often share the same joint action with the target
muscle, simply placing our hands on the location
of the target muscle and then choosing any one of
the target muscle’s actions to contract it is usually
not enough. If the action chosen is shared with an FCR
adjacent muscle, then the adjacent muscle will also
contract, making it very difficult to discern the tar-
get muscle from it.
For this reason, knowing which joint action to ask PL
the client to perform requires the therapist to be crea-
tive and to think critically. This knowledge is where the
A
art of muscle palpation begins. It requires knowledge
of not only of the actions of the target muscle, but also
the actions of all adjacent muscles. With this knowl-
edge, the client can be asked to perform the best joint
action for the palpation of the target muscle.
For example, if the flexor carpi radialis of the wrist
flexor group is the target muscle, then asking the
client to flex the hand at the wrist joint will engage
not only the flexor carpi radialis but also the other
two wrist flexor group muscles—the palmaris longus
and flexor carpi ulnaris. In this case, to palpate and
discern the flexor carpi radialis from the adjacent
palmaris longus and flexor carpi ulnaris, the client
should be asked to perform radial deviation of the B
hand at the wrist joint instead of flexion of the hand
at the wrist joint. This action will isolate the contrac- FIGURE 4-5 The flexor carpi radialis (FCR) muscle is engaged
tion to the flexor carpi radialis. It becomes palpably and palpated. A, If the client flexes the hand against resistance,
harder than the relaxed and palpably softer palmaris the adjacent palmaris longus (PL) also contracts, making it
longus and flexor carpi ulnaris muscles, which facili- difficult to discern the FCR. B, If the client, instead, radially
tate palpating and locating the flexor carpi radialis deviates the hand against resistance, the PL remains relaxed,
making it easier to discern the FCR.
(Figure 4-5).
application of many more guidelines. These additional therapist can add resistance to the client’s contraction
guidelines are presented in the following pages. After by resisting the forearm during pronation. This will
discussing each of the guidelines, a summary list of all require a more forceful contraction of the pronator
20 muscle palpation guidelines is given. Memorizing teres, making it easier to palpate and discern from the
a list this long is difficult, if not impossible; instead, adjacent musculature (Figure 4-6). When palpating,
these guidelines need to be learned by using them as the hand of the therapist that is doing the palpation is
the palpations of the skeletal muscles of the body are called the palpation hand. The other hand, in this case
discussed in Chapters 6 through 11 of this book. With offering resistance, is called the resistance hand.
4 practice, these guidelines will become familiar and Resisting a client’s target muscle contraction is not
comfortable to you and will enhance the art and sci- a battle between the therapist and client to see who is
ence of your muscle palpation technique. stronger. The role of the therapist is simply to oppose
the force of the client’s muscle contraction, not over-
Guideline 4: Add Resistance to the Contraction power the client. The degree that the client is asked to
of the Target Muscle contract the target muscle can vary. Ideally, it should
When a client is asked to perform one of the joint be the lightest amount necessary to bring out the target
actions of the target muscle to make it contract, muscle’s contraction so that it is palpable. However,
harden, and stand out, there are times when this a forceful contraction might be needed at times to
contraction is not forceful enough to make it eas- achieve this. A good guideline is to begin with a gentle
ily palpable. This is especially true if the joint action resistance as you try to palpate the target muscle. If it is
does not require a large body part to be moved not successful, then gradually increase the force of the
and/or if the body part that is moved is not moved resistance as necessary.
against gravity. When the client’s contraction of the When you ask the client to contract the target mus-
target muscle is not forceful enough, it might be nec- cle or to contract it against your resistance during pal-
essary for the therapist to add resistance so that the pation, remember to give the client a rest every few sec-
target muscle contracts harder and stands out more. A onds or so. Holding a sustained isometric contraction
good example is when the target muscle is the prona- can become uncomfortable and painful. It is more
tor teres and the client is asked to pronate the forearm comfortable for the client and actually better for our
at the radioulnar joints. Because the forearm is not palpation procedure if the client is asked to contract
a very large body part and pronation does not occur and relax the target muscle alternately instead of hold-
against gravity, the pronator teres muscle will con- ing a sustained isometric contraction. (See Guideline 9
tract, but most likely not forcefully enough to make for additional text on alternately contracting and relax-
it stand out and be easily palpable. In this case, the ing the target muscle.)
FIGURE 4-6 To create a more forceful contraction of the pronator teres muscle, the therapist can
hold on to the client’s distal forearm and resist forearm pronation at the radioulnar joints. Adding
resistance increases the contraction force of the client’s target muscle. The muscle “pops out”
and is easier to palpate. Note that the stabilization hand resisting the client’s forearm pronation is
placed on the distal forearm and does not cross the wrist joint to hold the client’s hand. Otherwise,
additional muscles are likely to contract, and the target muscle contraction will not be isolated.
Further, whenever the therapist adds resistance to palpate a target muscle, look first; then place your
the contraction of the target muscle, it is extremely palpating hand over the muscle to feel for it.
important not to cross any additional joints with the For example, when palpating the palmaris longus
placement of the stabilization hand. The goal of hav- and flexor carpi radialis muscles of the wrist flexor
ing a client contract the target muscle during palpa- group, before placing your palpating hand on the cli-
tion is to limit contraction to the target muscle. This ent’s anterior forearm, first look for the distal tendons of
way, it will be the only muscle that is palpably hard these two muscles at the anterior distal forearm near the
and can be discerned from the adjacent relaxed and wrist joint. They may be fully visible, aiding you in find-
palpably soft muscles. However, if the therapist’s sta- ing and palpating them (Figure 4-7, A). If they are not 4
bilization hand does cross other joints, it is likely that visible, ask the client to flex the hand at the wrist joint
muscles crossing these joints will also contract, which and add resistance if needed. Now, look again before
will defeat the purpose of having an isolated contrac- placing your palpating hand on the client. When con-
tion of the target muscle. tracted, these distal tendons will even more likely tense
For example, in the case of the pronator teres and visually pop out, helping you locate and palpate
palpation, when resistance to forearm pronation is them (Figure 4-7, B). The visual information of many
added, it is important that the therapist’s stabilization muscles can help with their palpation. For this reason, a
hand does not cross the wrist joint and hold the cli- good rule is to always "look before you touch."
ent’s hand. If the stabilization hand holds the client’s
hand, then other muscles that cross the client’s wrist Guideline 6: First Find and Palpate the Target
joint, such as the muscles of the wrist flexor group that Muscle in the Easiest Place Possible
move the hand at the wrist joint or flexor muscles of Once a target muscle has been found, continuing to
the fingers, will likely also contract, making it difficult palpate along its course is much easier than it is to
to discern the pronator teres from these adjacent mus- locate it in the first place. For this reason, a good pal-
cles. Therefore the resistance hand should be placed pation guideline is to always feel for the target muscle
on the client’s forearm (see Figure 4-6). Ideally, plac- wherever it is easiest to first find. Once located, you
ing the resistance hand on the distal end of the fore- can then continue to palpate it toward one or both
arm affords the best leverage force so that the therapist of its attachments. For example, using the flexor carpi
does not have to work as hard. radialis as an example, if the distal tendon is visually
Generally, if the therapist is resisting an action of apparent (see Figure 4-7), then begin your palpation
the arm at the glenohumeral joint, then the therapist’s there. Once it is clearly felt, then continue to palpate
stabilization hand should be placed just proximal toward its proximal attachment on the medial epicon-
to the elbow joint and not cross the elbow joint to dyle of the humerus.
grasp the client’s forearm. If the therapist is resisting
an action of the forearm at the elbow joint, then the Guideline 7: Strum Perpendicularly Across
therapist’s stabilization hand should be placed on the the Target Muscle
distal forearm and not cross the wrist joint to grasp the When first locating a target muscle or when following
client’s hand. If the therapist is resisting an action of a target muscle that has already been found, strum-
the hand at the wrist joint, then the therapist’s stabili- ming perpendicularly across its belly or tendon is best.
zation hand should be placed on the palm of the hand Strumming perpendicularly across a muscle belly or its
and not cross the metacarpophalangeal joints to grasp tendon is like strumming or twanging a guitar string;
the client’s fingers. The same reasoning can be applied you begin on one side of the belly or tendon, then you
to the lower extremity and the axial body. rise up onto its prominence, and then fall off the other
side of it. This change in contour is much more pal-
Guideline 5: Look Before You Palpate pably noticeable than if your palpating fingers simply
Although palpation is performed via touching, visual glide longitudinally along the muscle (which offers lit-
observation can be a valuable tool for locating a tar- tle change in contour and thus does not help define
get muscle. This is especially true for muscles that the location of the target muscle).
are superficial and whose contours show through When strumming perpendicularly across a muscle’s
the skin. Very often, a target muscle visually screams, belly or tendon, it is important to note that the move-
“Here I am!” yet the therapist does not see it because ment of your palpating fingers is not a short vibration
the palpating hand is in the way. This may be true motion; rather, it must be large enough to begin off
when the target muscle is relaxed but is even more one side of the target muscle, rise onto it, go all the way
likely to be true when the target muscle is contracted across it, and end off the other side of it. This means
(especially if it contracts harder from increased resist- that the length of excursion of your strumming motion
ance); when it contracts and hardens, it often pops must be fairly long. Figure 4-8 illustrates the belly of
out visually. For this reason, whenever attempting to the pronator teres being strummed perpendicularly.
FCU
FCR PL
FCR
A B
FIGURE 4-7 Looking for the presence of the target muscle is important before placing your
palpating hand over the target muscle and blocking possibly useful visual information. A, The distal
tendon of the flexor carpi radialis (FCR) muscle might be visible even when it is relaxed. B, When
contracted (against resistance, in this case), the distal tendon tenses and becomes even more
visually apparent. Note: the palmaris longus (PL) and flexor carpi ulnaris (FCU) tendons are also
visible.
Guideline 8: Use Baby Steps to Follow the Target

Muscle
Once a target muscle has been found in the easiest
place possible by strumming perpendicular to it, it
should then be followed all the way to its attachments.
This should be done in baby steps. Using baby steps
to follow a muscle means that each successive “feel”
of the muscle should be immediately after the previ-
ous feel so that no geography of the muscle’s contour
is skipped. If you feel the target muscle in one spot,
then you should not skip a couple of inches down the
muscle to feel it again. The farther down you skip, the
more likely it is that you will no longer be on the mus-
FIGURE 4-8 The pronator teres is being palpated by strumming cle and will lose the course of its palpation. Figure 4-9
perpendicularly across its belly. It is important that the excursion illustrates the idea that once a target muscle has been
of the strumming motion is large enough to begin off the muscle located, baby steps should be used to follow it toward
on one side and end off the muscle on its other side.
its attachments.
FIGURE 4-9 The pronator teres muscle is palpated in “baby steps” toward its distal attachment.
Palpating in baby steps means that the muscle is palpated with successive feels, each one
immediately after the previous one, which helps ensure that the therapist will successfully follow
the course of the target muscle.
Guideline 9: Alternately Contract and Relax Guideline 10: When Appropriate, Use Coupled
the Target Muscle Actions
As previously stated, it can be uncomfortable for the Knowledge of coupled actions can help isolate con-
client to hold a sustained isometric contraction of the traction of a target muscle in certain instances to facil-
target muscle while it is being palpated; therefore it is itate palpation. Most of these instances involve rota-
better for the client to alternately contract and relax it. tion of the scapula at the scapulocostal joint, because
In addition, having the client alternately contract and scapular rotation cannot occur on its own; rather, the
relax the target muscle while the therapist follows its scapula can only rotate when the arm is moved at the
course with baby steps aids in successful palpation. If glenohumeral joint. For example, although it has a
the target muscle alternately contracts and then relaxes number of actions that could be used to make it con-
at each baby step of the palpation process, then the tract, if the pectoralis minor is the target muscle to
therapist can feel its change in texture from being soft be palpated, most of these actions would also cause
when it is relaxed, to being hard when it is contracted, the pectoralis major to contract, which would block
and to being soft when it is relaxed again. This assures palpation of the pectoralis minor. The only effective
the therapist that he or she is still on the target mus- action that would isolate contraction of the pectora-
cle. If the therapist does accidentally veer off the tar- lis minor in the anterior chest is downward rotation
get muscle onto other tissue, then it will be evident of the scapula. However, this rotation will occur only
because the tissue texture change from soft to hard to in conjunction with extension and/or adduction of
soft (as the target muscle contracts and then relaxes) the arm at the glenohumeral joint. Therefore to cre-
will not be felt. ate downward rotation of the scapula to engage the
When the therapist does veer off course, the pal- pectoralis minor, ask the client to extend and adduct
pating fingers should be placed back at the last spot the arm at the glenohumeral joint. This action can be
where the target muscle was clearly felt and then make accomplished by first having the client rest the hand
the next baby step in a slightly different direction to in the small of the back; then, to engage the pectora-
relocate the course of the target muscle as the client is lis minor, have the client move the arm further into
asked once again to contract and then relax the target extension by moving the hand posteriorly away from
muscle alternately. the small of the back. This action will immediately
engage the pectoralis minor, allowing it to be easily Guideline 11: When Appropriate, Use Reciprocal
palpated through the pectoralis major (Figure 4-10). Inhibition
This same procedure can be used to palpate the Reciprocal inhibition is a neurologic reflex that causes
rhomboid muscles through the middle trapezius (see inhibition of a muscle whenever an antagonist mus-
Figure 6-7). cle is actively contracted. This neurologic reflex can be
used to great advantage when palpating certain target
Note: Knowledge of coupled actions can also be used
muscles.
with reciprocal inhibition to palpate a target muscle. For
For example, if our target muscle is the brachialis
example, when palpating the levator scapulae, the client’s
4 and we want to make it contract so that it hardens and
arm is extended and adducted at the glenohumeral joint
is easier to feel, we have no choice but to ask the client
by placing the hand in the small of the back. This requires
to flex the elbow joint because that is the only action
the coupled action of downward rotation of the scapula
of the brachialis. The problem with this action is that if
at the scapulocostal joint, which then reciprocally inhibits
the client flexes the forearm at the elbow joint to con-
and relaxes the upper trapezius (because it is an upward
tract the brachialis, the biceps brachii will also contract.
rotator of the scapula). With the upper trapezius relaxed,
This contraction makes it difficult to palpate the bra-
the levator scapulae can be palpated through it. (For a
chialis because the biceps brachii overlies the brachialis
fuller explanation of this, see the discussion on reciprocal
in the anterior arm. Given that it is always the goal of a
inhibition, Guideline 11.)
muscle palpation to have an isolated contraction of the
target muscle (in this case, we want only the brachialis
to contract), the biceps brachii needs to remain relaxed.
Although the only action of the brachialis (elbow joint
flexion) is an action of the biceps brachii, achieving iso-
lated contraction is possible if we use the principle of
reciprocal inhibition (Figure 4-11). To do this, we ask
the client to flex the forearm at the elbow joint while
the forearm is in a position of full pronation. Because
Biceps brachii muscle
Brachialis muscle
FIGURE 4-10 When the client moves the hand posteriorly away FIGURE 4-11 The principle of reciprocal inhibition is used to
from the small of the back, extension of the arm occurs. This inhibit and relax the biceps brachii muscle as the brachialis
requires the coupled action of downward rotation of the scapula muscle contracts to flex the forearm at the elbow joint. The
at the scapulocostal joint, which engages the pectoralis minor biceps brachii, which is also a supinator of the forearm, is
muscle so that it can be easily palpated through the pectoralis reciprocally inhibited because the forearm is pronated (as it is
major muscle. flexed).
the biceps brachii is also a supinator of the forearm, Note: Occasionally, a deep muscle palpation is facilitated
having the forearm pronated will reciprocally inhibit it by extremely light pressure. If a muscle is so deep that its
from contracting; consequently, it will remain relaxed as borders cannot be felt, then its location must be determined
the brachialis contracts to flex the forearm at the elbow by feeling for the vibrations of its contraction through the
joint. Thus we have achieved the goal of having an iso- tissues. This can only be felt with a very light touch.
lated contraction of our target muscle, the brachialis.
Another example of using the principle of recip-
rocal inhibition to isolate the contraction of a target
muscle is palpating the scapular attachment of the Guideline 13: For Deep Palpations, Sink Slowly 4
levator scapulae. If we ask the client to elevate the into the Tissue and Have the Client
scapula to contract and palpably harden the leva- Breathe
tor scapulae, the upper trapezius will also contract All deep muscle palpations should be performed
and harden, making it impossible to feel the levator slowly. Although deep pressure can be uncom-
scapulae at its scapular attachment deep to the upper fortable for many clients, it is often accomplished
trapezius. To stop the upper trapezius from contract- quite easily if we work with the client as we palpate.
ing, ask the client to place the hand in the small of the Sinking slowly into the client’s tissues and having
back. This position of humeral extension and adduc-
tion requires downward rotation of the scapula at the
scapulocostal joint. Because the upper trapezius is an
upward rotator of the scapula, it will be reciprocally
inhibited and stay relaxed. This position allows for an
isolated contraction of and a successful palpation of
the levator scapulae when the client is asked to elevate
the scapula (Figure 4-12). Levator scapulae
One important caution is provided when using the
principle of reciprocal inhibition for a muscle palpa- Upper trapezius
tion. When the client is asked to contract and engage
the target muscle, the force of its contraction must be
small. If the contraction is forceful, the client’s brain
will override the reciprocal inhibition reflex in an
attempt to recruit as many muscles as possible for the
joint action, and contraction of the muscle that was
supposed to be reciprocally inhibited and relaxed will
be the result. Once this other muscle contracts, it will
likely block successful palpation of the target mus-
cle. For example, when palpating for the brachialis, if
flexion of the forearm at the elbow joint is performed
forcefully, the biceps brachii will be recruited, mak-
ing palpation of the brachialis difficult or impossible.
Another example is palpating for the levator scapulae:
if elevation of the scapula at the scapulocostal joint is
performed forcefully, then the upper trapezius will be
recruited, making palpation of the levator scapulae at
its scapular attachment difficult or impossible.
Guideline 12: Use Appropriate Pressure

It is important to avoid being too heavy handed; sen-
sitivity can be lost with excessive pressure. On the
other hand, it is important to not be too light with
FIGURE 4-12 The principle of reciprocal inhibition is used
your pressure either; some muscles are quite deep and to inhibit and relax the upper trapezius so that the scapular
require moderate-to-strong pressure to feel. Generally, attachment of the levator scapulae can be more easily palpated
when most new students have a difficult time palpat- as it contracts to elevate the scapula at the scapulocostal
ing a target muscle, it is because their pressure is too joint. The upper trapezius, which is also an upward rotator of
light. Appropriate pressure means applying the opti- the scapula, is reciprocally inhibited because the scapula is
mal palpation pressure for each target muscle palpa- downwardly rotated (as it is elevated) because of the position of
the hand in the small of the back.
tion (Figure 4-13).
A B
FIGURE 4-13 Use pressure that is appropriate to the structure being palpated. When the medial
and lateral epicondyles of the humerus are being palpated, only light pressure is needed (A).
However, when the psoas major muscle is palpated, deeper pressure is required (B).
the client breathe with the palpation process in a Guideline 14: Use Muscles as Landmarks
slow and rhythmic manner can accomplish this. An Once the bones and bony landmarks of the skel-
excellent example is palpating the psoas major in eton have been learned, using a bony landmark to
the abdominopelvic cavity. The psoas major must be help locate and palpate a target muscle is common.
palpated from the anterior perspective. Because the However, once the palpation of one muscle has been
psoas major lies against the spinal column and forms learned, it can also be a useful landmark for locating
part of the posterior abdominal wall, firm pressure is another adjacent muscle. For example, if palpation
required to reach through the abdominal viscera. For of the sternocleidomastoid (SCM) has been learned,
the client to remain comfortable, the therapist needs then it is a simple matter to palpate the scalene mus-
to sink into the client’s tissues very slowly as the cli- cles (see page 283). Locating the lateral border of the
ent breathes slowly and evenly. To begin the palpa- clavicular head of the SCM and then dropping off it
tion, ask the client to take in a moderate-to-deep immediately laterally are all that is required; you will
breath; then, as the client slowly exhales, slowly sink be on the scalene group. This way is a much easier to
in toward the psoas major. Reaching the psoas major locate the scalenes than to first try to palpate the ante-
is not necessary at the end of the client’s first exha- rior tubercles of the transverse processes of the cervical
lation. Instead, ease off slightly with your pressure vertebrae. Similarly, the SCM can also be used to locate
and ask the client to take in another moderate-sized and palpate the longus colli muscle (see page 294).
breath; then continue to sink slowly in deeper as the First locate the medial border of the sternal head of
client slowly exhales again. This process may need to the SCM and then drop it off just medially and sink in
be repeated a third time to reach the psoas major; a toward the spinal column. Countless other examples
deep muscle can usually be accessed in this manner exist wherein knowledge of one muscle’s location can
with two or three breaths by the client. What is most help the therapist locate another muscle that might
important to remember is that firm deep pressure otherwise be difficult to find.
must be applied slowly.
Guideline 15: Relax and Passively Slacken
Note: When having a client breathe with your palpation as the Target Muscle When Palpating
you sink slowly and deeply in the client’s tissues to access its Bony Attachment
a deep muscle, it is important that the client’s breath is not Palpating as much of a target muscle as possible is
quick and shallow. However, the breaths do not need to be always desirable; preferably it should be palpated all
very deep either; a very deep breath may push your palpat- the way from one bony attachment to its other bony
ing hands out, especially if you are palpating in the abdomi- attachment. However, following a target muscle all the
nal region. The pace of the breath is more important. The way to its bony attachment is difficult at times. This
client’s breathing should be slow, rhythmic, and relaxed. is especially true if the client is contracting the target
This type of breathing on the part of the client is facilitated muscle, because this tenses and hardens its tendon,
if you breathe in a similar manner. making it difficult to discern from its bony attachment.
Ironically, although contracting the target muscle helps them lightly or firmly, which can interfere with palpa-
us discern its belly from adjacent soft tissue because tion assessment and also with treatment. Asking the
the muscle belly becomes hard, contracting the target client to place one of his or her hands over our palpat-
muscle tenses and hardens the tendon of the muscle as ing hand is one technique that can be done to help
well, which makes it harder to discern the hard tendon lessen the sensitivity of a ticklish client. Ticklishness
from the adjacent hard bony tissue of its attachment. is a perceived invasion of one’s space by another indi-
In other words, contracting a target muscle helps vidual, which is why a person cannot tickle him or
discern it from adjacent soft tissue, but contracting herself. Therefore if the client’s hand is placed over our
it makes it more difficult to discern it from adjacent palpating hand, the client will subconsciously have 4
hard tissue, such as its bony attachments. Therefore a sense that he or she is in control of this space and
having the client relax the target muscle and having will tend to be less ticklish. Using this guideline does
the target muscle passively slackened as the therapist not work with everyone in every circumstance, but it is
reaches its bony attachment is one guideline that can worth trying and often successful.
help the therapist follow a target muscle all the way to
its bony attachment. Examples that use this guideline Guideline 19: Keep Fingernails Short and Smooth
are palpating the proximal attachment of the rectus For some muscle palpations, the therapist’s fingernails
femoris muscle on the anterior inferior iliac spine need to be very short (Figure 4-14, A), especially when
(AIIS) of the pelvis (see Figure 10-26) and palpating it comes to deep palpations such as when palpating
the distal attachment of the subscapularis muscle on the subscapularis muscle (see Figure 6-23), quadratus
the lesser tubercle of the humerus (see Figure 6-23). lumborum muscle (see Figure 8-16), or the vertebral
attachments of the scalene muscles (see Figure 8-35).
Guideline 16: Close Your Eyes When You Palpate Unfortunately, everyone has a different sense of what
Although visually inspecting the palpation region is short means when it comes to the length of fingernails.
important when beginning palpation of the target As a result, some therapists allow their nails to be
muscle (see Guideline 5), once the visual inspection too long. Consequently, they are unable to palpate
is done, it is often not necessary for a therapist to con- some muscles comfortably and either cause pain and
tinue looking at the client’s body as the palpation pro- leave fingernail marks on the client or, just as bad,
cedure continues. In fact, it can be greatly beneficial if avoid adequately palpating or working musculature
the therapist closes his or her eyes when palpating. By of the client that is in need of treatment because
closing the eyes, the therapist can block out extrane- they are afraid of hurting the client with their nails.
ous sensory stimuli that might otherwise distract from The exact fingernail length that is necessary will vary
what is being felt in the palpation finger pads. Closing from one palpation to another. A good way to check
the eyes allows the therapist to focus all attention on for appropriate fingernail length is to place the pads
the palpating fingers, thereby increasing their sensory of your palpating hand fingers away from you and try
acuity. to catch the fingernails of your palpating hand with a
fingernail of your other hand (Figure 4-14, B). If you
Guideline 17: Construct a Mental Picture can, then the fingernails are likely too long. If you
of the Client’s Anatomy Under cannot, then the length of your fingernails is short
the Skin as You Palpate enough for deep palpations.
As the therapist’s eyes are closed during palpation, pic- Just as important, fingernails must be smooth (i.e.,
turing the target muscle and other adjacent anatomic their edges are not sharp). When filing fingernails,
structures under the client’s skin can also be beneficial. finishing with a fingernail file that buffs and smooths
Creating this mental picture of the client’s anatomy the edges of the nails is important. Short nails that are
under the skin can facilitate correct initial location of sharp can be just as uncomfortable or painful to the
the target muscle and facilitate the use of baby steps as client as long fingernails.
the target muscle is followed toward its attachments.
Guideline 20: Use the Optimal Palpation Position
Guideline 18: If a Client Is Ticklish, Have The optimal palpation position is simply the client
the Client Place a Hand Over Your position that is most effective for the palpation of a
Palpating Hand particular target muscle. It is important to realize that
Unfortunately, when clients are ticklish, palpating the optimal position in which to palpate a certain
them is often difficult if not impossible because touch- target muscle might not be the position that a client
ing causes them to pull away. This is especially true if is usually in when that muscle is being treated. Clients
we touch the client lightly. Therefore using firm pres- are usually treated in the prone or supine position.
sure is usually best to palpate ticklish clients. However, However, some muscles are optimally palpated with
some clients are extremely ticklish whether we touch the client side lying, standing, or seated. For example,
to the assessment and treatment of the client, it might

be necessary to do so. To avoid this interruption to the
flow of a treatment session, the therapist may choose
to do all palpation assessments at the beginning of the
session before commencing with treatment.
Apply Guidelines and Be Creative

4 Although the science of muscle palpation begins with a
solid knowledge of the attachments and actions of the
target muscle, turning palpation into an art requires
much more. The art of muscle palpation involves
weaving the knowledge of the attachments and actions
of the target muscle and all adjacent musculature, as
well as the many guidelines listed in this chapter, into
a cohesive approach that allows the target muscle to
A be discerned from adjacent tissues. Overall, what are
necessary are sensitive hands, critical thinking, and a
willingness to be creative.
Summary List of Muscle Palpation

Guidelines
Each of the following muscle palpation guidelines has
already been discussed in this chapter. All 20 are sum-
marized in the following list:
1. Know the attachments of the target muscle to
know where to place your hands.
2. Know the actions of the target muscle. The client
will most likely be asked to perform one of them
to contract the target muscle so that it can be dis-
cerned from the adjacent musculature. (Make sure
that the client is not asked to hold the contraction
too long or the target muscle may fatigue and the
B client may become uncomfortable.)
3. Think critically to choose exactly which joint action
FIGURE 4-14 Fingernails need to be very short for muscle
palpations, especially of deep muscles. A, The proper length for of the target muscle will best isolate its contraction.
fingernails when palpating and working deeply is shown. B, An 4. If necessary, add resistance to the client’s con-
easy way to check whether fingernail length is short enough for traction of the target muscle. (When resistance is
deeper palpations is seen. See if you can catch the fingernails added, do not cross any joints that do not need to
of your palpating hand (when the pads are oriented away be crossed; in other words, be sure to resist only
from you) with a fingernail of your other hand. If you can, that the desired action of the target muscle
fingernail may be too long.
5. Look before placing your palpating hand on the
client. (This is especially important with superfi-
cial muscles.)
the pectoralis minor is most often treated with the 6. First find and palpate the target muscle in the easi-
client supine. However, the optimal client position est place possible.
in which to palpate the pectoralis minor is probably 7. Strum perpendicularly across the belly or tendon
seated. This is because the seated position better allows of the target muscle.
the client to first place the hand in the small of the 8. Once located, follow the course of the target muscle
back and then move the hand posteriorly away from in small successive baby steps.
the small of the back (creating downward rotation of 9. At each baby step of palpation, have the client
the scapula to engage the pectoralis minor) (see Figure alternately contract and relax the target muscle
6-14, B). For this reason, although it is usually preferred and feel for this tissue texture change as the mus-
to not have the client change positions in the middle cle goes from relaxed and soft, to contracted and
of a treatment session, if accurate palpation is critical hard, to relaxed and soft again.
10. Use your knowledge of coupled actions to palpate 14. Once the palpation of one muscle is known, it can
target muscles that are scapular rotators. be used as a landmark to locate other muscles.
11. Use reciprocal inhibition whenever needed to aid 15. Relax and passively slacken the target muscle when
palpation of the target muscle. (When reciprocal palpating it at its bony attachment.
inhibition is used, do not have the client contract 16. Close your eyes when you palpate to focus your
the target muscle too forcefully, or the muscle that attention on your palpating fingers.
is being reciprocally inhibited may be recruited 17. Construct a mental picture of the client’s anatomy
anyway.) under the skin as you palpate.
12. Use appropriate pressure. Appropriate pressure is 18. If the client is ticklish, use firm pressure and have 4
neither too heavy nor too light. the client place a hand over your palpating hand.
13. When using deep palpation pressure, sink slowly 19. Fingernails need to be very short and smooth.
into the client’s tissues as the client breathes 20. Place the client in a position that is optimal for
slowly and evenly. the muscle palpation.
REVIEW QUESTIONS
website at http://evolve.elsevier.com/Muscolino/knowthebody.
1. What are the two major objectives of palpation? 6. For what type of muscle is it important to look
before you touch?
4 ________________________________________________
________________________________________________
________________________________________________
7. Where should a muscle be first palpated?
2. When should we be palpating our clients? a. At its proximal attachment
a. At the beginning of the session b. At its distal attachment
b. At the end of the session c. At the mid belly
c. When the client is in pain d. At the easiest place possible to locate the muscle
d. Whenever we are contacting them
8. In what direction should we orient our palpating
3. What two guidelines make up the “science of stroke relative to the target muscle?
muscle palpation?”
________________________________________________
________________________________________________
9. What term describes that each successive “feel” of
________________________________________________ a muscle should be immediately after the previous
one?
4. When asking the client to contract to palpate the
target muscle, which of the following is our goal? ________________________________________________
a. Contraction of the target muscle and its synergists
b. Contraction of the target muscle only 10. What reflex can be used to relax a muscle that has
c. Contraction of the target muscle and all nearby the same actions as the palpation target muscle?
muscles
d. Inhibition and relaxation of the target muscle ________________________________________________
5. Where on the client’s body should the therapist’s

stabilization/resistance hand be placed when
palpating and engaging the pronator teres?
a. Arm
b. Forearm
c. Palm of hand
d. Fingers
CHAPTER
Bony Palpation
5
CHAPTER OUTLINE
Upper Extremity, 117
Axial Body, 124
Lower Extremity, 131
C hapter 5 offers a palpation tour of bones, bony

landmarks, and joints of the human body. The
tour begins with the upper extremity, then addresses
can be independently palpated, this chapter is set up
sequentially to flow from one landmark to another;
therefore following the order presented here is
the axial body, and concludes with the lower recommended.
extremity. Although any one bone or bony landmark
UPPER EXTREMITY
ANTEROMEDIAL VIEW ANTEROMEDIAL VIEW
Acromion process
Head of
humerus
FIGURE 5-2 Clavicle: Find the notch at the superior border of
Sternum the sternum and palpate laterally, feeling for the sternoclavicular
joint. From there, slide along the shaft of the clavicle from
Coracoid process Clavicle Suprasternal notch medial to lateral (proximal to distal) to feel its entire length.
Notice that the medial end of the clavicle is convex anteriorly
FIGURE 5-1 Anteromedial view of the shoulder girdle. and the lateral end of the clavicle is concave anteriorly.
117
ANTEROMEDIAL VIEW ANTEROMEDIAL VIEW
FIGURE 5-3 Coracoid process of the scapula: From the FIGURE 5-4 Acromion process of the scapula: After palpating
concavity at the lateral (distal) end of the clavicle, drop the coracoid process of the scapula, move back to the clavicle
inferiorly off the clavicle to find the coracoid process of the and continue palpating the clavicle laterally (distally) once again
scapula (located deep to the pectoralis major muscle). When until you reach the acromion process of the scapula. The
palpating the coracoid process, notice that its apex (tip) acromion process of the scapula is at the far lateral end (i.e., the
points laterally. tip of the shoulder).
POSTEROLATERAL VIEW
Superior angle
Supraspinous fossa
Superior border
Infraspinous fossa
Spine of scapula
Medial border Acromion process
Lateral border
Inferior angle
FIGURE 5-5 Posterolateral view of the scapula.

Chapter 5 Bony Palpation 119
POSTEROLATERAL VIEW
A B
FIGURE 5-6 Acromion process and spine of the scapula: The spine of the scapula is the posterior
continuation of the acromion process. To locate the spine of the scapula, begin on the acromion
process (A), and continue palpating along it posteriorly. The spine of the scapula (B) can be palpat-
ed all the way to the medial border of the scapula. The spine of the scapula can be best palpated
if you strum it perpendicularly by moving your palpating fingers up and down across it as you work
your way posteriorly and then medially.
POSTEROLATERAL VIEW POSTEROLATERAL VIEW
FIGURE 5-7 Medial border of the scapula (at the root of the FIGURE 5-8 Superior angle of the scapula: Once the medial
spine of the scapula): Continue palpating along the spine of the border of the scapula has been located, palpate along it
scapula until you reach the medial border of the scapula. superiorly until you reach the superior angle of the scapula.
Where the spine of the scapula ends at the medial border Having the client elevate and depress the scapula as you
is called the root of the spine of the scapula. Passively palpate for its superior angle can be helpful.
retracting the client’s scapula makes it much easier to locate the
medial border.
FIGURE 5-9 Inferior angle of the scapula: Palpate along the FIGURE 5-10 Lateral border of the scapula: Once you are at the
medial border of the scapula from the superior angle down to inferior angle of the scapula, continue palpating superiorly along
the inferior angle of the scapula. the lateral border of the scapula. It is easiest to feel the lateral
border if your pressure is directed medially. Although challenging,
the lateral border of the scapula can usually be palpated all the
way to the infraglenoid tubercle of the scapula, just inferior
to the glenoid fossa of the scapula. To confirm that you are on
the infraglenoid tubercle, ask the client to extend the forearm at
the elbow joint against resistance to bring out the infraglenoid
attachment of the long head of the triceps brachii (you can
provide the resistance or the client can provide the resistance
by pressing the forearm against his or her own thigh).
ANTEROLATERAL VIEW SUPERIOR VIEW
A B C D
FIGURE 5-11 Greater tubercle, bicipital groove, and lesser tubercle of the humerus: The greater
tubercle is located on the lateral side of the bicipital groove; the lesser tubercle is located on
the medial side. First locate the anterolateral margin of the acromion process of the scapula and
then immediately drop off it onto the head of the humerus; you should be on the greater tubercle
of the humerus (A and B). Now, with a flat finger pad palpation across the anterior surface of the
head of the humerus, passively move the client’s arm into lateral rotation at the glenohumeral joint.
You should be able to feel your palpating finger dropping into the bicipital groove as it passes
under your finger pads (C). As you continue to move the client’s arm passively into lateral rotation,
you will then feel the lesser tubercle under your fingers, just medial to the bicipital groove (D). If
you do not successfully feel the tubercles and bicipital groove, alternately move the client’s arm
through medial and lateral rotation, feeling for them.
POSTERIOR VIEW POSTERIOR VIEW
A B
FIGURE 5-12 Medial and lateral epicondyles of the humerus: To locate the medial FIGURE 5-13 Olecranon process of the ulna:
and lateral epicondyles of the humerus, ask the client to flex the forearm at The olecranon process of the ulna is
the elbow joint to approximately 90 degrees; place your palpating fingers on the extremely easy to locate. With the thumb
medial and lateral sides of the client’s arm (A) and move distally down the client’s and middle finger on the medial and lateral
arm. Your palpating fingers will clearly run into the medial and lateral epicondyles epicondyles of the humerus, place your index
of the humerus; they will prominently be the widest points along the sides of the finger on the olecranon process, located
humerus near the elbow joint (B). halfway between the two epicondyles.
NOTES: (1) If the client’s elbow joint is
flexed, the olecranon process will be located
farther distally than the two epicondyles of the
humerus. (2) Because of the presence of the
ulnar nerve, known in lay terms as the “funny
bone,” be careful with palpatory pressure
between the medial epicondyle of the humer-
us and the olecranon process of the ulna.
LATERAL VIEW
FIGURE 5-14 Radial head: The radial head lies at the proximal end of the radius. To palpate it,
begin at the lateral epicondyle of the humerus and drop immediately distal to it. Feeling the joint
space between the head of the radius and the humerus is possible. To bring out the radial head,
place two fingers on either side (proximal and distal) of it and ask the client to alternately pronate
and supinate the forearm at the radioulnar joints; the spinning of the head of the radius can be felt
under your fingers.
LATERAL VIEW LATERAL VIEW
Dorsal tubercle of radius
Styloid process of ulna
Trapezium
FIGURE 5-16 Styloid process of the radius: Find the lateral shaft
of the radius and continue palpating it distally until you reach the
Styloid process styloid process of the radius located at the distal end.
Saddle joint Scaphoid of radius NOTE: A small portion of the distal lateral radial shaft is
not directly palpable because it is deep to three deep thumb
FIGURE 5-15 Lateral view of the wrist/hand. muscles of the posterior forearm.
FIGURE 5-17 Dorsal (Lister's) tubercle: The dorsal tubercle FIGURE 5-18 Styloid process of the ulna: The styloid process
(also known as Lister's tubercle) is located on the posterior of the ulna is located at the distal end of the ulna on the
side of the distal end of the radius. From the styloid process posterior side. From the dorsal tubercle of the radius, move
of the radius, palpate posteriorly onto the radius; the dorsal medially onto the posterior surface of the distal ulna and feel for
tubercle will be a prominence located in the middle of the distal the prominence of the ulnar styloid.
posterior radial shaft.
ANTERIOR (PALMAR) VIEW
Radius
Tubercle of scaphoid Triquetrum
Pisiform
Tubercle of trapezium
Hook of hamate
FIGURE 5-19 Anterior (palmar) view of the wrist.
A B
FIGURE 5-20 Tubercles of scaphoid and trapezium: The tubercles of the scaphoid and trapezium
are prominent and palpable anteriorly on the hand. To locate them, palpate the lateral (radial)
surface of the anterior hand and feel for two bony prominences. A, The tubercle of the scaphoid
is the smaller, more proximal one of the two. B, The tubercle of the trapezium is the larger, more
distal bony prominence.
NOTE: The tubercle of the trapezium is located approximately ½ inch distal to the tubercle of
the scaphoid.
A B
FIGURE 5-21 Pisiform and hook of the hamate: The pisiform is a carpal bone located anteriorly
on top of the triquetrum in the proximal row of carpals on the ulnar side. The pisiform is prominent
and easily palpated on the anterior side of the wrist, just distal to the ulna (A). The hamate is also
easily palpated anteriorly in the palm. Specifically, the hook of the hamate is palpable here. Begin
by locating the pisiform; then palpate approximately ½ to ¾ inch distal and lateral (i.e., toward the
midline of the hand) from the pisiform (B).
NOTE: The hook of the hamate is fairly pointy and can be somewhat tender to palpation.
AXIAL BODY
INFEROLATERAL VIEW INFEROLATERAL VIEW
Maxilla Nasal bone
Zygomatic Mandible
bone
Coronoid
process
Body
Ramus
Angle
Zygomatic arch
of thetemporal bone Condyle
FIGURE 5-22 An oblique (inferolateral) view of the face. FIGURE 5-23 Body and angle of the mandible: The body of the
mandible is subcutaneous and easily palpable. Begin palpating
the inferior border of the body of the mandible anteriorly and
continue palpating it laterally and posteriorly until the angle
of the mandible is reached. The angle of the mandible is the
transition area where the body of the mandible becomes the
ramus of the mandible.
FIGURE 5-24 Ramus (posterior border) and condyle of the man- FIGURE 5-25 Zygomatic bone: The zygomatic bone, commonly
dible: The ramus of the mandible branches off from the body referred to as the cheekbone, is easily palpated inferolateral to
of the mandible at the angle of the mandible. The posterior the eye. Once located, explore the zygomatic bone to its bor-
border of the ramus is fairly easy to palpate for its entire course ders with the maxilla, frontal bone, and temporal bone.
and gives rise to the condyle (of the ramus) of the mandible.
To palpate the ramus, begin at the angle of the mandible and
palpate superiorly along the posterior border until the condyle
is reached, anterior to the ear. To bring out the condyle, ask
the client to alternately open and close the mouth. This allows
one to feel the movement of the condyle of the mandible at the
temporomandibular joint (TMJ).
NOTE: The condyle can also be palpated from within the ear.
Wearing a finger cot or glove, gently place your palpating finger
inside the client’s ear, press anteromedially, and ask the client
to alternately open and close the mouth. The movement of the
condyle of the mandible at the TMJ will be clearly palpable.
LATERAL VIEW
A B
FIGURE 5-26 Temporal bone: To palpate the zygomatic arch of the temporal bone, first find
the zygomatic bone (see Figure 5-25). Once located, continue palpating the zygomatic bone
posteriorly until you reach the zygomatic arch of the temporal bone (A). Strumming your
fingers vertically over the zygomatic arch can be helpful. The entire length of the zygomatic arch of
the temporal bone can be palpated.
To palpate the mastoid process of the temporal bone, palpate just posterior to the earlobe,
then press medially and strum over the mastoid process by moving your palpating finger anteriorly
and posteriorly (B).
LATERAL VIEW
FIGURE 5-27 External occipital protuberance

(EOP): The EOP is a midline bump on the superior
nuchal line of the occiput at the back of the head.
The EOP is usually fairly large and prominent and
therefore readily palpable.
LATERAL VIEW FIGURE 5-28 A lateral view of the neck.

Hyoid bone NOTE: With all palpations in the anterior neck,
Thyroid cartilage a careful and sensitive touch is necessary and
palpatory pressure must be applied gradually. Many
structures in the anterior neck are very sensitive
Cricoid
and can be tender. Furthermore, the carotid arteries
cartilages
are found in the anterior neck; pressure on them
cannot only potentially restrict blood flow within
them to the anterior brain, but it can also trigger a
Carotid
tubercle neurologic reflex (the carotid reflex) that can lower
blood pressure. For this reason, palpating the
Transverse anterior neck unilaterally (i.e., one side at a time) is
processes best. If you feel that your palpating fingers are on
the carotid artery, either move slightly off it or gently
C7 displace it from your palpating fingers. Generally,
palpation of the structures of the anterior neck is
best accomplished if the client’s neck is relaxed
and either in a neutral position or a position of slight
C1 passive flexion. Some of the following palpations are
cartilage structures, not bony landmarks.
LATERAL VIEW
FIGURE 5-29 Hyoid bone: The hyoid bone is found

in the anterior neck, inferior to the mandible (located
at the level of the third cervical vertebra). To find
the hyoid bone, begin at the mandible and move
inferiorly in the anterior neck until you feel hard bony
tissue. Once on the hyoid bone, ask the client to
swallow, and movement of the hyoid bone will be
felt. The hyoid bone is very mobile, and passively
moving it from side to side is possible.
NOTE OF TRIVIA: The hyoid bone is the only
bone in the human body that does not articulate
(form a joint) with another bone.
LATERAL VIEW
FIGURE 5-30 Thyroid cartilage: The thyroid cartilage is located

in the anterior neck, inferior to the hyoid bone (the thyroid
cartilage is located at the level of the fourth and fifth cervical
vertebrae). Once the hyoid bone has been located, drop off it
5
inferiorly; you will feel a joint space and then the thyroid cartilage
will be felt. Palpate the small midline superior notch; then
gently palpate both sides of the thyroid cartilage. Movement of
the thyroid cartilage will be clearly felt if the client is asked to
swallow. Palpation of the thyroid cartilage must be done gently
and carefully because the thyroid gland often overlies part of the
thyroid cartilage.
LATERAL VIEW
A B
FIGURE 5-31 Transverse processes of C1 through C7: The transverse processes (TPs) of C2
through C7 are bifid (i.e., each TP has two points instead of one) and have anterior tubercles
and posterior tubercles. These TPs may be palpated but must be palpated with gentle
pressure because their tubercles are pointy; pressing the overlying musculature into them can be
tender for the client. Begin by finding the carotid tubercle (anterior tubercle of the TP of C6); then
palpate inferiorly and superiorly to find the other TPs. The direction of your pressure should be
posterior and/or posteromedial (A).
The TP of C1 (the atlas) has the widest transverse process of the cervical spine. The TP of
C1 can be palpated at a point that is directly posterior to the posterior border of the ramus of the
mandible, directly anterior to the mastoid process of the temporal bone, and directly inferior to the
ear. In this depression of surrounding soft tissue, the hard TP of C1 will be readily palpable (B).
NOTES: (1) Pressure on the TP of C1 should be gentle because this landmark is often
sensitive and tender to pressure, and the facial nerve (CN VII) is located nearby. (2) The TP of C1
is much more anterior than most therapists expect.
FIGURE 5-32 Spinous processes of C2 through C7: The spinous

processes (SPs) of the cervical spine are palpated in the
midline of the posterior neck. There are seven cervical vertebrae;
however, not all of the cervical SPs are always palpable.
LATERAL VIEW Because of the lordotic curve of the spine of the neck (concave
posteriorly), the SPs are often deep in the concavity and therefore
difficult to palpate. The exact number of cervical SPs that can
be palpated is primarily determined by the degree of the lordotic
cervical curve of the client. The most prominent cervical SPs are
those of C2 and C7; these two are always palpable.
Begin by finding the external occipital protuberance in the
5 midline of the occiput. From there, drop inferiorly off the occiput
onto the cervical spine; the first cervical SP that will be palpable
will be the SP of C2. As with most cervical SPs, the C2 SP is
bifid. It should be noted that these bifid points are not always
symmetrical; one may be larger than the other. From C2,
continue palpating inferiorly, feeling for additional cervical SPs.
In some individuals, the next SP that will be readily palpable
will be the one on C7 at the inferior end of the cervical spine.
The SP of C7 is clearly larger than the other lower cervical SPs,
giving C7 the name vertebra prominens. In other individuals
who have a decreased cervical spinal curve, palpating and
counting all the SPs from C2 to C7 may be possible.
NOTE: C1 (the atlas) does not have an SP; it has what is
called a posterior tubercle. To palpate the posterior tubercle
of C1, palpate between the SP of C2 and the occiput, pressing
anteriorly into the soft tissue.
FIGURE 5-33 Laminar groove of the cervical spine: The laminar FIGURE 5-34 Articular processes (facets) of the cervical spine:
groove of the cervical spine is the groove that is found between The inferior and superior articular processes that create the
the spinous processes medially and the articular processes facet joints of the cervical spine also create what is called
laterally (i.e., the laminar groove overlies the laminae of the the articular pillar or the cervical pillar because of the way
vertebrae). A number of muscles lie in the laminar groove; they are stacked. They are easily palpable at the lateral side of
consequently, direct palpation of the laminae at the floor of the the laminar groove (approximately 1 inch lateral to the spinous
laminar groove is difficult. Palpate just lateral to the spinous processes). The client must be supine and relaxed for palpation
processes and you will be in the laminar groove. to be successful. Begin palpation at the spinous process of C2
and palpate laterally past the laminar groove and feel for the
articular process of C2. Continue to palpate inferiorly until you
reach the bottom of the neck.
NOTE: The articular processes of the cervical spine are an
excellent contact point when performing joint mobilizations to
the cervical spine.
SUPEROLATERAL VIEW
Costal cartilage of 3rd rib Xiphoid process
Manubrium
Body of sternum
7th rib
Suprasternal notch
Iliac crest
1st rib
11th rib 5
Clavicle
Second intercostal space
FIGURE 5-35 Superolateral view of the anterior trunk.
SUPEROLATERAL VIEW SUPEROLATERAL VIEW
FIGURE 5-36 Suprasternal notch of the sternum: The FIGURE 5-37 Xiphoid process of the sternum: The xiphoid
suprasternal notch of the manubrium of the sternum process of the sternum is at the inferior end of the sternum.
is subcutaneous and easily palpable. Simply palpate at the The xiphoid process is cartilaginous but may calcify into bone
superior border of the sternum, and the depression of the as a person ages. To locate the xiphoid process, continue
suprasternal notch will be readily felt between the medial ends palpating inferiorly along the anterior surface of the sternum until
of the two clavicles. you feel the small, pointy xiphoid process at the inferior end.
NOTE: The suprasternal notch is also known as the jugular Because the xiphoid process is made of cartilage, exerting mild
notch. pressure on it and feeling it move are possible.
NOTE: The xiphoid process is a landmark often used to
find the proper hand position to administer cardiopulmonary
resuscitation (CPR).
SUPEROLATERAL VIEW ANTEROLATERAL VIEW
A B
FIGURE 5-38 Anterior rib cage: The anterior side of the rib cage is composed of 12 ribs, 7 costal
cartilages that join the ribs to the sternum, and the 11 intercostal spaces located between the
adjacent ribs and/or costal cartilages. All ribs, costal cartilages, and intercostal spaces can be
palpated anteriorly and anterolaterally (except where the breast tissue of female clients interferes
with palpation). The ribs and/or costal cartilages will be sensed as hard bony/cartilaginous tissue
located subcutaneously, and the intercostal spaces will be sensed as depressions of soft tissue
located between the ribs and/or the costal cartilages. Once each rib has been successfully
palpated, try to follow it medially and laterally for its entire course, as far as possible.
To palpate ribs 2 through 10: Palpate the anterior rib cage lateral to the sternum. Generally, for
ribs 2 through 10, identifying them by strumming across them in a superior to inferior manner is
easiest. The first intercostal space is inferior to the medial end of the clavicle and between the first
and second ribs. From there, palpate inferiorly and count the intercostal spaces and ribs until you
find the seventh costal cartilage (A). Because of the contour of the rib cage, continuing to palpate
ribs 7 through 10 and their costal cartilages more laterally in the anterior trunk is best.
To palpate ribs 11 and 12: Ribs 11 and 12 are called floating ribs because they do not articulate
with the sternum. They must be palpated at the bottom of the rib cage, superior to the iliac crest,
in the lateral and/or posterolateral trunk. Palpating ribs 11 and 12 is easiest by pressing directly
into and feeling for their pointy ends.
NOTE: This pressure should be firm but gentle because you are pressing soft tissue into the
hard pointy end of a bone.
To palpate the first rib: The first rib is probably the most challenging to palpate, but it can be felt.
To palpate the first rib, find the superior border of the upper trapezius muscle and then drop off it
anteriorly and direct your palpatory pressure inferiorly against the first rib (B). Asking the client to take
in a deep breath will elevate the first rib up against your palpating fingers and make palpation easier.
POSTEROLATERAL VIEW
SP of T6
Lamina of T7 TP of T6
9th rib SP of T1
5th rib
FIGURE 5-39 Superolateral view of the posterior trunk. SP, Sinous process; TP, transverse process.
FIGURE 5-40 Spinous processes of the trunk: The spinous FIGURE 5-41 Transverse processes (TPs) of the trunk: The TPs
processes (SPs) of the 12 thoracic and 5 lumbar vertebrae are of the trunk can be challenging to discern, but many of them
all palpable. Begin by locating the SP of C7 (also known as the can be palpated. Usually the TPs of the thoracic region can be
vertebra prominens). It will usually be the first very prominent SP felt approximately 1 inch lateral to the spinous processes (SPs).
inferior to the SP of C2. However, to determine the exact vertebral level of a TP can be
When the client is prone, if confusion exists as to which SP difficult, because it is not located at the same level as the SP
is C7, the following method will determine it. Palpate the SPs of the same vertebra. To determine the level of the TP that is
of the lower cervical spine with fingers on two or three of the being palpated, use the following method. Place one palpating
prominent ones. Then passively flex and extend the client’s finger on an SP, then press down onto the TPs nearby one at a
head and neck. The SP of C6 will disappear from palpation with time until you feel the pressure upon a TP move the SP that is
extension; the SP of C7 will not (i.e., the SP of C7 will be the under the palpating finger. The vertebral level of that TP will be
highest SP palpable during flexion and extension). the same as that of the SP that moved. This method is usually
Once the SP of C7 has been located, palpate each vertebral successful for the thoracic spine; palpation of the TPs of the
SP by placing your middle finger on the SP of that vertebra and lumbar spine is much more challenging.
your index finger in the interspinous space between that verte-
bra and the vertebra below. Continue palpating down the spine in
this manner. Counting the SPs from C7 to L5 is usually possible.
NOTE: The SPs of the thoracic region are usually easily
palpable because of the kyphotic thoracic spinal curve.
However, palpating the lumbar SPs is a bit more challenging
because of the lordotic lumbar spinal curve; to accomplish this,
deeper pressure may be needed.
LOWER EXTREMITY
OBLIQUE VIEW
Sacrum Second sacral tubercle
Coccyx PSIS
Sacrococcygeal joint
Ischial tuberosity Iliac crest
FIGURE 5-42 An inferolateral oblique view of the posterior pelvis. PSIS, Posterior superior iliac spine.
SUPEROLATERAL VIEW SUPEROLATERAL VIEW
FIGURE 5-43 Iliac crest: The iliac crest is subcutaneous and FIGURE 5-44 The posterior superior iliac spine: The posterior
easily palpable. With the client prone, place your palpating superior iliac spine (PSIS) is the most posterior aspect of the
fingers on the iliac crest and follow it as far anterior as possible. iliac crest and is usually visually prominent and easily palpable. It
It ends at the anterior superior iliac spine (ASIS). Then follow the is located approximately 2 inches from the midline of the superior
iliac crest posteriorly to the posterior superior iliac spine (PSIS). aspect (the base) of the sacrum. The PSIS is easily located
because the skin drops in around the medial side of it, forming
a dimple in most individuals. Visually locate the dimple first; then
palpate into it, pressing slightly laterally against the PSIS.
FIGURE 5-45 Sacrum: From the posterior superior iliac spine FIGURE 5-46 Coccyx: The coccyx is located directly inferior to
(PSIS), palpate the midline of the sacrum, feeling for the sacral the sacrum. It is subcutaneous and usually easily palpable. At
tubercles. Once a sacral tubercle is located, continue palpating the most superior aspect of the coccyx, the sacrococcygeal
superiorly and inferiorly for the other sacral tubercles. The joint can usually be palpated.
second sacral tubercle is usually at the level of the PSIS.
NOTE: The sacroiliac (SI) joint, located between the
sacrum and ilium on each side, is not directly palpable because
of the overhang of the PSIS and the presence of the joint
ligaments.
INFEROLATERAL VIEW
5
Gluteal fold
FIGURE 5-47 Ischial tuberosity: The ischial tuberosity is located deep to the gluteal fold, slightly
medial to the midpoint of the buttock. Palpating it from the inferior perspective is best so that the
palpating fingers do not have to palpate through the gluteus maximus. Moderate-to-deep pressure
is necessary to palpate the ischial tuberosity; however, its palpation is not difficult and is usually
not tender for the client. Once located, strum across the ischial tuberosity both horizontally and
vertically to palpate it in its entirety.
INFEROLATERAL VIEW
ASIS
L5
Pubic tubercle
Sacrum
FIGURE 5-48 An inferolateral view of the anterior pelvis. ASIS, Anterior superior iliac spine.
FIGURE 5-49 Anterior superior iliac spine: The anterior superior FIGURE 5-50 Pubic bone and pubic tubercle: The pubic bone
iliac spine (ASIS) is the most anterior aspect of the iliac crest. is located at the most inferior aspect of the anterior abdomen.
It is usually visually prominent and easily palpable. From the iliac The pubic tubercle is on the anterior surface of the body
crest (see Figure 5-43), continue palpating anteriorly until you of the pubic bone near the pubic symphysis joint and is at
reach the ASIS. approximately the same level as the superior aspect of the
greater trochanter of the femur. To locate the pubic bone, begin
by palpating more superiorly on the anterior abdominal wall,
then carefully and gradually palpate farther inferiorly, pressing
gently into the abdominal wall until the pubic bone is felt. It
helps to use the ulnar side of the hand and direct the pressure
posteriorly and inferiorly. It is important that the abdominal wall
muscles are relaxed so that when the pubic bone is reached, it
will be readily felt.
DISTAL VIEW DISTAL AND MEDIAL VIEW
FIGURE 5-51 Greater trochanter: Begin palpation of the FIGURE 5-52 Lesser trochanter: The lesser trochanter of the
thigh by locating the greater trochanter of the femur. The femur is located in the proximal medial thigh. It is a palpable
greater trochanter is located in the proximal lateral thigh at landmark but is appreciably more challenging to discern;
approximately the same level as the public tubercle. It is fairly palpating it with certainty requires more advanced palpation
large (approximately 1½ ⫻ 1½ inches) and subcutaneous; skills and knowledge of the psoas major muscle. To locate the
hence, it is fairly easy to palpate; strum along the greater lesser trochanter of the femur, the distal aspect of the psoas
trochanter vertically and horizontally to feel the entire landmark. major muscle must be located (see page 360). Once located,
follow the psoas major distally as far as possible. Then have
the client relax his or her thigh in a position of flexion and lateral
rotation of the thigh at the hip joint to relax and slacken the
psoas major; then press in against the femur, feeling for the
lesser trochanter.
DISTAL AND ANTERIOR VIEW ANTEROLATERAL VIEW
Patella
Femur
Femoral Patella
condyles
Knee
joint
5
Tibial
Head of fibula condyles
FIGURE 5-53 Patella: The patella (kneecap) is

a prominent sesamoid bone located anterior to
the distal femur. To best palpate the patella, have Tibial tuberosity
the client supine with the lower extremity relaxed.
Palpate the entire patella, gently gliding along the
patella horizontally and vertically.
Medial
Lateral malleolus
malleolus
FIGURE 5-54 Anterolateral view of the leg with the knee joint flexed to 90 degrees.
ANTEROLATERAL VIEW ANTEROLATERAL VIEW
FIGURE 5-55 Femoral condyles: The inferior margins of the FIGURE 5-56 Tibial condyles: The superior margins of the
medial femoral condyle and lateral femoral condyle are medial tibial condyle and lateral tibial condyle are palpable
palpable by pressing proximally up against the femur from the joint by pressing distally down against the tibia from the joint line of
line of the knee on both sides of the patella. Once located, palpate the knee on both sides of the patella. Once located, palpate
farther proximally onto the medial and lateral femoral condyles. farther distally onto the medial and lateral tibial condyles.
FIGURE 5-57 Head of the fibula: As you continue palpating FIGURE 5-58 Tibial tuberosity: The tibial tuberosity is a
along the superior margin of the lateral condyle of the tibia, prominent landmark located at the center of the proximal shaft
you will reach the head of the fibula. The head of the fibula of the anterior tibia, approximately 1 to 2 inches distal to the
is the most proximal landmark of the fibula, is located on the inferior margin of the patella. The quadriceps femoris muscle
posterolateral side of the knee, and can be palpated anteriorly, group attaches onto the tibial tuberosity.
laterally, and posteriorly.
NOTE: The common fibular nerve is superficial near the head
of the fibula; therefore care should be taken when palpating here.
ANTEROLATERAL VIEW
FIGURE 5-59 Tibial shaft: From the tibial tuberosity, the entire anteromedial tibial
shaft is subcutaneous and easily palpable. Begin palpating at the tibial tuberosity
and continue palpating distally until you reach the medial malleolus at the end of
the anteromedial tibial shaft.
FIGURE 5-60 Medial malleolus: The medial malleolus of the FIGURE 5-61 Lateral malleolus: The lateral malleolus of the
tibia is the very prominent bony landmark at the ankle region fibula is the very prominent bony landmark that is located at the
that is located on the medial side. As you palpate down the lateral side of the ankle region. The lateral malleolus is the distal
shaft of the tibia, you will reach the medial malleolus. Palpate expanded end of the fibula. Notice that the lateral malleolus of
the circumference of this large bony landmark. the fibula is located somewhat farther distal than is the medial
malleolus of the tibia.
MEDIAL VIEW
MTP joint
1st metatarsal Navicular tuberosity
1st cuneiform
Proximal phalanx
Medial malleolus of tibia
IP joint
Distal phalanx
Sustentaculum tali
of calcaneus
FIGURE 5-62 Medial view of the foot. IP, Interphalangeal; MTP, metatarsophalangeal.
MEDIAL VIEW MEDIAL VIEW
FIGURE 5-63 Sustentaculum tali of the calcaneus: From the FIGURE 5-64 Navicular tuberosity: From the sustentaculum tali,
medial malleolus of the tibia, drop your palpating finger approxi- move your palpating fingers approximately 1 inch anteriorly and
mately 1 inch distally; the sustentaculum tali of the calcaneus the navicular tuberosity is quite prominent and palpable.
should be palpable. The sustentaculum tali forms a shelf upon
which the talus sits. The joint line between the sustentaculum
tali and the talus above is often palpable.
LATERAL VIEW
Styloid process
of base of 5th
metatarsal Cuboid 5th metatarsal
Proximal, middle
Lateral malleolus and distal phalanges
of fibula
Calcaneus
FIGURE 5-65 Lateral view of the foot.
LATERAL VIEW
A B
FIGURE 5-66 Fifth metatarsal: Palpate the lateral border of the foot and feel for the fifth metatarsal.
The dorsal and lateral surfaces of the fifth metatarsal are readily palpable. Palpate from the
expanded distal head to the middle of the shaft of the fifth metatarsal (A). Continue palpating
proximally until you reach the large expanded proximal base (B). The base of the fifth metatarsal
flares out and is called the styloid process of the fifth metatarsal.
LATERAL VIEW PLANTAR VIEW
Sesamoid bones
5th metatarsal overlying 1st
head metatarsal head
5
1st cuneiform
Cuboid
FIGURE 5-67 Cuboid: Just proximal to the fifth metatarsal along Talus
the lateral side of the foot is a depression where the cuboid
lies. The depression is created by a combination of the flaring
of the base of the fifth metatarsal (the styloid process of the fifth Calcaneal
metatarsal) and the concave shape of the lateral border of the tuberosity
cuboid. Palpate with firm pressure medially into this depression
and the cuboid can be felt.
FIGURE 5-68 Plantar view of the foot.
PLANTAR VIEW PLANTAR VIEW
FIGURE 5-69 Metatarsal heads of toes one through five: The

heads of all five metatarsals are palpable on the plantar surface of
the foot. Although all five metatarsals are palpable, because of the
concavity of the transverse arch of the foot, the heads of the first
and fifth metatarsals are most prominent. Begin by palpating FIGURE 5-70 Calcaneal tuberosity: The calcaneal tuberosity
the head of the fifth metatarsal and then continue medially, can often be palpated on the plantar side of the foot. With the
palpating each of the other four metatarsal heads. Overlying the client’s foot relaxed, palpate with firm pressure on either side
plantar surface of the head of the first metatarsal are two small of the midline of the plantar side of the calcaneus. The medial
sesamoid bones. When palpating the head of the first metatarsal aspect of the calcaneal tuberosity is usually more prominent
on the plantar side, it is actually the two sesamoids that are felt. than the lateral aspect.
REVIEW QUESTIONS
Fill in the correct answer for each of the following questions. More study resources are provided on the Evolve website at
http://evolve.elsevier.com/Muscolino/knowthebody.
1. What bony landmark of the scapula is found by 6. What are the two most prominent spinous
dropping inferiorly off the lateral clavicle? processes of the cervical spine?
________________________________________________ ________________________________________________
5 2. What bony landmark is found at the “tip of the ________________________________________________

shoulder?”
7. What bony landmark of the spine is found between
________________________________________________ the spinous processes medially and the articular
processes laterally?
3. What bony landmarks are found at the widest
points of the distal humerus near the elbow joint? ________________________________________________
________________________________________________ 8. What is the most posterior aspect of the iliac

crest?
________________________________________________
________________________________________________
4. What are the two most prominent bony landmarks
found on the medial side of the anterior hand? 9. What is the prominent bony landmark found at the
midline of the proximal anterior tibia?
________________________________________________
________________________________________________
________________________________________________
10. What is the prominent bony landmark found
5. What landmark of the temporal bone is found approximately 1 inch distal to the medial malleolus
directly posterior to the earlobe? of the tibia?
________________________________________________ ________________________________________________
CHAPTER
Muscles of the Shoulder Girdle
and Arm 6
over the scapula, and on the arm. Trapezius, latissimus
CHAPTER OUTLINE
dorsi, and pectoralis major are large superficial
Overview of Function: Muscles of the Shoulder muscles located on the trunk. Deltoid, triceps brachii,
Girdle, 141 and biceps brachii (and to some degree the brachialis)
Overview of Function: Muscles of the are large superficial muscles located on the scapula
Glenohumeral Joint, 142 and arm.
As a general rule, muscles that move the shoul-
Overview of Function: Muscles of the Elbow der girdle have their origin (proximal attachment) on
and Radioulnar Joints, 142 the trunk and their insertion (distal attachment) on
the scapula or clavicle or both. These muscles move
MUSCLES OF THE SHOULDER GIRDLE the scapula relative to the rib cage wall (trunk) at the
Trapezius, 146 scapulocostal joint and/or the clavicle at the sterno-
Rhomboids Major and Minor, 148 clavicular joint.
Muscles that move the arm have their origin
Levator Scapulae, 150
(proximal attachment) on the trunk, clavicle, or scapula
Serratus Anterior, 152 and their insertion (distal attachment) on the humerus.
Pectoralis Group, 154 These muscles move the arm relative to the scapula at
Pectoralis Major the glenohumeral joint.
Muscles that move the forearm have their origin
Pectoralis Minor
(proximal attachment) on the scapula or humerus and
Detour to Subclavius, 157 their insertion (distal attachment) on the radius or ulna.
Latissimus Dorsi (Lat) and Teres Major, 158 The companion CD at the back of this book allows
Rotator Cuff Group, 162 you to examine the muscles of this body region, layer
by layer, and individual muscle palpation technique vid-
Supraspinatus
eos are available in the Chapter 6 folder on the Evolve
Infraspinatus website.
Teres Minor
Subscapularis
OVERVIEW OF FUNCTION: MUSCLES
MUSCLES OF THE ARM OF THE SHOULDER GIRDLE
Deltoid, 166 The following general rules regarding actions can be
Coracobrachialis, 168 stated for the functional groups of muscles of the
Biceps Brachii, 170 shoulder girdle:
Q If a muscle attaches to the scapula and its other
Brachialis, 172
attachment is superior to the scapula, it can elevate
Triceps Brachii, 174 the scapula at the scapulocostal joint.
Anconeus, 176 Q If a muscle attaches to the scapula and its other
attachment is inferior to the scapula, it can depress
the scapula at the scapulocostal joint.
T he muscles of this chapter are involved with

the motions of the shoulder girdle (scapula and
clavicle), arm (humerus), and forearm (radius and ulna).
Q If a muscle attaches to the scapula and its other
attachment is medial to the scapula on the pos-
terior side (i.e., closer to the spine), it can retract
The bellies of these muscles are located on the trunk, (adduct) the scapula at the scapulocostal joint.
141
Q If a muscle attaches to the scapula and its other Q Lateral rotators of the arm wrap around the humerus
attachment is lateral to the scapula (i.e., closer to from medial to lateral, posterior to the gleno-
the anterior surface of the body), it can protract humeral joint.
(abduct) the scapula at the scapulocostal joint. Q Reverse actions of these standard (typical) mover
If a muscle attaches to the scapula away from the actions involve the scapula being moved relative
axis of scapular rotation (i.e., off axis), it can rotate to the humerus at the glenohumeral joint (the
the scapula either upwardly or downwardly at the scapula will also be moved relative to the rib cage
scapulocostal joint. The rotation that the scapula at the scapulocostal joint). These reverse actions are
performs depends on where it attaches. usually either rotation or tilt actions of the scapula.*
Q Any muscle that moves the scapula at the scapulo-
costal joint can do the same motion of the clavicle
at the sternoclavicular joint (and vice versa). OVERVIEW OF FUNCTION: MUSCLES
6 Q Reverse actions of these standard (typical) mover
actions involve the scapula being fixed and the
OF THE ELBOW AND RADIOULNAR
other attachment moving toward the scapula at the JOINTS
scapulocostal joint.* The following general rules regarding actions can be
stated for the functional groups of muscles of the
elbow and radioulnar joints:
OVERVIEW OF FUNCTION: MUSCLES OF Q If a muscle crosses the elbow joint anteriorly with a
THE GLENOHUMERAL JOINT vertical direction to its fibers, it can flex the forearm
at the elbow joint by moving the anterior surface of
The following general rules regarding actions can be the forearm toward the anterior surface of the arm.
stated for the functional groups of muscles of the Q If a muscle crosses the elbow joint posteriorly with
glenohumeral joint: a vertical direction to its fibers, it can extend the
Q If a muscle crosses the glenohumeral joint anteri- forearm at the elbow joint by moving the posterior
orly with a vertical direction to its fibers, it can flex surface of the forearm toward the posterior surface
the arm at the glenohumeral joint by moving the of the arm.
anterior surface of the arm toward the scapula. Q Reverse actions at the elbow joint involve mov-
Q If a muscle crosses the glenohumeral joint poste- ing the arm toward the forearm at the elbow joint.
riorly with a vertical direction to its fibers, it can This movement usually occurs when the hand (and
extend the arm at the glenohumeral joint by mov- therefore the forearm) is fixed by holding onto an
ing the posterior surface of the arm toward the immovable object.*
scapula. Q If a muscle crosses the radioulnar joints anteriorly
Q If a muscle crosses the glenohumeral joint laterally with a horizontal orientation to its fibers, it will
(superiorly, over the top of the joint), it can abduct pronate the forearm at the radioulnar joints by
the arm at the glenohumeral joint by moving the crossing the radius over the ulna.
lateral surface of the arm toward the scapula. Q If a muscle crosses the radioulnar joints posteriorly
Q If a muscle crosses the glenohumeral joint medi- with a horizontal direction to its fibers, it will supi-
ally (inferiorly, below the center of the joint), it nate the forearm at the radioulnar joints by moving
can adduct the arm at the glenohumeral joint by the radius to be parallel with the ulna.
moving the medial surface of the arm toward the Q Reverse actions of these standard (typical) mover
scapula. actions at the radioulnar joints involve moving
Q Medial rotators of the arm wrap around the the ulna toward the radius at the radioulnar joints.
humerus from medial to lateral, anterior to the This movement usually occurs when the hand (and
glenohumeral joint. therefore the radius) is fixed by holding onto an
immovable object.*
*A standard (typical) mover action is when the insertion (distal attachment) moves toward
the origin (proximal attachment). A reverse mover action occurs when the origin moves
toward the insertion.
Posterior View
of the Muscles of the
Shoulder Girdle Region
Mastoid process of temporal bone
6
Trapezius Levator scapulae
Fascia over infraspinatus

Supraspinatus
Spine of scapula
Infraspinatus
Deltoid
Teres minor
Teres major
Rhomboids
Triceps brachii
Inferior angle
of scapula
Latissimus dorsi
FIGURE 6-1 The left side is superficial. The right side is deep (the deltoid, trapezius, sternocleido-
mastoid, and infraspinatus fascia have been removed).
143
Anterior View of the
Muscles of the Shoulder
Atlas (C1)
Girdle Region
Hyoid bone
Levator scapulae
First rib
Subclavius
Trapezius
6
Coracoid process
Omohyoid
of scapula
Deltoid
Subscapularis
Pectoralis Pectoralis
major minor
Coracobrachialis
Serratus
Triceps anterior
brachii
Biceps
brachii
Brachialis
FIGURE 6-2 The right side is superficial. The left side is deep (the deltoid, pectoralis
major, trapezius, scalenes, omohyoid, and muscles of the arm have been removed; the
sternocleidomastoid has been cut).
144
Right Lateral View of the
Muscles of the Shoulder
Girdle Region
Hyoid bone
Sternocleidomastoid
Levator scapulae
Trapezius
Acromion process of scapula
Clavicle
Pectoralis major
Deltoid
Scapula
Serratus anterior
FIGURE 6-3
145
SHOULDER GIRDLE AND ARM

Trapezius
Pronunciation tra-PEE-zee-us
The trapezius is a broad flat superficial muscle

that overlies the neck and middle and upper
back. It is considered to have three parts:
upper, middle, and lower. The trapezius is
functionally important for neck and shoulder
6
girdle motions (Figure 6-4).
Upper trapezius
I
Middle trapezius
O
Lower trapezius
FIGURE 6-4 Posterior view of the

right trapezius. O, Origin; I, insertion.
WHAT’S IN A NAME? ACTIONS

The name, trapezius, tells us that this muscle is The trapezius moves the scapula at the scapulocostal
shaped similar to a trapezoid ( ). joint and moves the head and neck at the spinal joints.
Derivation: Upper Fibers
trapezius: Gr. a little table (or trapezoid shape) Q Elevate the scapula.
Q Upwardly rotate the scapula.
Q Retract the scapula.
ATTACHMENTS
Q Extend the head and neck.
Origin (Proximal/Medial Attachment) Q Laterally flex the head and neck.
Q External occipital protuberance, medial one third Q Contralaterally rotate the head and neck.
of the superior nuchal line of the occiput, nuchal Middle Fibers
ligament, and spinous processes of C7-T12
Q Retract the scapula.
Insertion (Distal/Lateral Attachment) Lower Fibers

Q Lateral one third of the clavicle, acromion process, Q Depress the scapula.
and spine of the scapula Q Upwardly rotate the scapula.
Chapter 6 Muscles of the Shoulder Girdle and Arm 147
STABILIZATION the upper trapezius and palpate it in the neck up to

its occipital attachment (Figure 6-5, B).
1. Stabilizes the shoulder girdle.
4. Note that the upper trapezius is quite narrow; it only
2. Stabilizes the head, neck, and trunk.
attaches to the medial one third of the superior nuchal
Stabilization Function Note: The upper trapezius is extremely line of the occiput. The semispinalis capitis muscle,
important for stabilizing the shoulder girdle when the arm is the largest muscle in the neck, is deep to the upper
abducted and/or flexed at the glenohumeral joint. trapezius.
TREATMENT CONSIDERATIONS
INNERVATION
Q Many positions require postural isometric
■ Spinal accessory nerve (cranial nerve [CN] XI) contraction overuse of the
upper trapezius. These 6
positions include
holding the head
PALPATION inclined anteriorly
when working in front
1. Ask the client to lie prone with the arm resting on the
of the body using a
table at the side of the body. hand-held electronic
2. To palpate the lower and middle trapezius, place the device such as a smart
palpating finger pads just lateral to the lower and mid- phone, carrying a purse
dle thoracic spine. Then ask the client to abduct the or bag on the shoulder (regardless of the weight), crimping
a telephone between the ear and the shoulder, holding the
arm to 90 degrees with the elbow joint extended;
arm outward in an abducted position, or carrying a heavy
and slightly retract the scapula by pinching the shoul- weight in the hand.
der blade toward the spine. Adding gentle resistance
Q Weakness of the trapezius can contribute to the condition
to the client’s arm abduction with your support hand
of rounded/slumped shoulders.
is usually helpful. Palpate perpendicular to the fibers
Q Because the greater occipital nerve pierces through the
between the spine and scapula (Figure 6-5, A).
upper trapezius, when the upper trapezius is tight, it can
3. To palpate the upper trapezius, ask the client to compress this nerve, which causes a tension headache.
extend the head slightly. Look for the engagement of This condition is also known as greater occipital neuralgia.
A B
FIGURE 6-5 A, To engage the entire right trapezius, the client abducts the arm at the glenohumeral
joint (resistance can be added as shown) and slightly retracts the scapula at the scapulocostal
joint. B, Palpation of the upper trapezius is shown. Asking the client to extend the head and neck
slightly at the spinal joints facilitates palpation of the upper trapezius. For all three parts of the
trapezius, palpate by strumming perpendicular to the fiber direction as shown.

Rhomboid Major; Rhomboid Minor
Pronunciation 2/- BOYD-!9 JOR s 2/- BOYD-9 NOR
The rhomboid muscles are located

in the interscapular region between
the spine and the scapula, deep to
the trapezius and superficial to the
6 erector spinae and transversospinalis
musculature (Figure 6-6).
Rhomboid minor
O
Rhomboid major I
FIGURE 6-6 Posterior view of the

right rhomboids major and minor.
The levator scapulae has been
ghosted in. O, Origin; I, insertion.
WHAT’S IN A NAME? ATTACHMENTS

The name, rhomboids, tells us that these muscles Origin (Proximal/Medial Attachment)
have the geometric shape of a rhombus (a parallelo-
Q Minor: spinous processes of C7-T1
gram or diamond shape). Major and minor tell us
that the rhomboid major is larger than the rhomboid Q Major: spinous processes of T2-T5
minor.
Derivation: Insertion (Distal/Lateral Attachment)
rhomb: Gr. rhombos (geometric shape)
oid: Gr. shape, resemblance
Q Minor: medial border of the scapula at the root of the
major: L. larger spine of the scapula
minor: L. smaller Q Major: medial border of the scapula between the root
of the spine and the inferior angle of the scapula
ACTIONS
The rhomboids move the scapula at the scapulocostal
joint. Upper fibers:
■ Retract the scapula.
■ Elevate the scapula.
■ Downwardly rotate the scapula.
STABILIZATION
1. Stabilize the shoulder girdle.
2. Stabilize the C7-T5 vertebrae.
6
INNERVATION
A
■ Dorsal scapular nerve
PALPATION
1. Ask the client to lie prone or sit with the hand resting
in the small of the back.
2. Ask the client to lift the hand away from the small of
the back.
3. First look for the lower border of the rhomboids to
become visible; then palpate the rhomboids between
the spine and scapula (Figure 6-7).
Q Rounded/slumped shoulders is a
common postural condition in
which the scapulas are protracted
(abducted) and depressed
and the arms are medially
rotated. Considering the
rhomboids’ actions of both
retraction and elevation of the
scapula, when they are weak,
they can contribute to this
common condition because
they are unable to oppose
efficiently the tight protractors
and depressors of the scapula B
(pectoralis muscles).
Q The rhomboids often blend into the FIGURE 6-7 A, The inferior border of the rhomboids is often
serratus anterior on the anterior visible. B, Palpate perpendicular to the fiber direction of the
side of the scapula; they are rhomboids.
both part of the spiral line
myofascial meridian.
Q A good way to remember
the direction of fibers of the
rhomboids is to think of
them as the “Christmas
Tree Muscles.”

Levator Scapulae
Pronunciation le-VAY-tor SKAP-you-lee
The levator scapulae is a muscle of

the shoulder girdle and neck. At its
scapular attachment, it is located
deep to the trapezius; at its spinal
attachment, it is located deep to the
6
sternocleidomastoid; its mid belly is
superficial in the posterior triangle of
the neck (Figure 6-8). O
Levator scapulae
FIGURE 6-8 Posterior view of

the right levator scapulae. The
trapezius has been ghosted in.
O, Origin; I, insertion.

The name, levator scapulae, tells us that this muscle The levator scapulae moves the scapula at the
elevates the scapula. scapulocostal joint and moves the neck at the spinal
Derivation: joints.
levator: L. lifter ■ Elevates the scapula.
scapulae: L. of the scapula ■ Downwardly rotates the scapula.
■ Extends the neck.
ATTACHMENTS ■ Laterally flexes the neck.
■ Ipsilaterally rotates the neck
Origin (Proximal/Superior Attachment)
Q Transverse processes of C1-C4
STABILIZATION
Insertion (Distal/Inferior Attachment)
Q Medial border of the scapula, between the superior 1. Stabilizes the shoulder girdle.
angle and the root of the spine of the scapula 2. Stabilizes the upper cervical spinal joints.
INNERVATION
Q Dorsal scapular nerve
PALPATION
1. Ask the client to lie prone or sit with the hand
resting in the small of the back (Figure 6-9, A). Place
palpating finger pads immediately superior to the
superior angle of the scapula.
2. Ask the client to perform a gentle, very short range
of motion of elevation of the scapula and feel for the 6
levator scapulae deep to the trapezius (Figure 6-9, B).
3. Continue palpating superiorly until you are off the
trapezius and in the posterior triangle of the neck.
Now you can ask the client to elevate the scapula
more forcefully (Figure 6-9, C).
4. Follow superiorly and anteriorly toward the transverse
processes of C1-C4.
Note: The transverse process of C1 is immediately inferior

to the ear.
Q Many positions require postural isometric
contraction overuse of the levator A
scapulae. These positions include
holding the head inclined
anteriorly when working in
front of the body using a
hand-held electronic device
such as a “smart phone,”
carrying a purse or bag on
the shoulder (regardless of
the weight), crimping a
telephone between the ear
and shoulder, or carrying
a heavy weight in the hand.
Q The levator scapulae often becomes tight and visible in
middle and older age as it contracts to maintain the posture B
of the upper neck and head.
Q At approximately the midpoint of the levator scapulae, a
twist in the fibers creates an increased density that may be
mistaken for a trigger point.
FIGURE 6-9 A, The levator scapulae can be easily palpated

with the client seated. B, Palpation near the superior angle of
the scapula is shown (where the levator scapulae is deep to the
trapezius). C, Palpation is shown where the levator scapulae is
superficial in the posterior triangle of the neck. C

Serratus Anterior
Pronunciation SER ! TUSAN 4%% RI OR
The serratus anterior is a

broad muscle that is located
between the scapula and
rib cage wall (along with
the subscapularis). It hugs
6
the rib cage wall and is
superficial on the lateral rib
cage wall, below the axilla
(armpit) (Figure 6-10).
When well developed, its
slips of tissue look similar to
ribs. I
FIGURE 6-10 Lateral view of the right

serratus anterior. O, Origin; I, insertion.

The name, serratus anterior, tells us that this muscle Origin (Proximal/Anterior Attachment)
has a serrated appearance and is anterior (to the ser- Q Ribs one through nine
ratus posterior superior and serratus posterior inferior)
Derivation:
serratus: L. notching
Insertion (Distal/Posterior Attachment)
anterior: L. in front Q Anterior surface of the entire medial border of the
scapula
ACTIONS
The serratus anterior moves the scapula at the scapulo-
costal joint:
■ Protracts the scapula.
■ Upwardly rotates the scapula.
STABILIZATION
2. Stabilizes the rib cage.
Stabilization Function Note: The serratus anterior stabilizes 6

the scapula to prevent winging (lateral tilt) of the scapula.
INNERVATION
■ Long thoracic nerve
PALPATION
1. The client is supine with the arm straight up in the
air pointed toward the ceiling; place the finger pads
against the lateral rib cage wall, directly inferior to the
axilla (armpit).
A
2. Resist the client from reaching the hand toward the
ceiling (Figure 6-11, A).
3. Palpate the serratus anterior where it is superficial on
the rib cage (Figure 6-11, B); then palpate the rest
of the muscle, reaching deep to the pectoralis major
and the scapula.
Q When weak, the serratus
anterior can contribute to
winging (lateral tilt) of the
scapula. B
Q The serratus anterior
usually blends into the FIGURE 6-11 A, Starting position for supine palpation of the
rhomboids on the anterior right serratus anterior. B, Palpation of the right serratus anterior
side of the scapula. against the lateral rib cage wall.
SHOULDER GIRDLE AND ARM: Pectoralis Group

Pectoralis Major; Pectoralis Minor
Pronunciation 0%+ TO RA LIS-!9 JOR s 0%+ TO RA LIS-9 NOR
The pectoralis major and minor muscles are located in the pectoral
(chest) region. The pectoralis major is considered to have two heads,
a clavicular head and a sternocostal head; it is superficial, attaches to
the arm, and creates the anterior axillary fold of tissue that borders
the axilla (the armpit) anteriorly. The pectoralis minor is deep to the
6 pectoralis major and attaches to the scapula (Figure 6-12).
I
Clavicular head O
Sternocostal head
FIGURE 6-12 Anterior view of the right pectoralis major and left pectoralis minor. The deltoid
has been ghosted in on the right side. The coracobrachialis and cut pectoralis major have been
ghosted in on the left side. O, Origin; I, insertion.

The name, pectoralis, tells us that these muscles
are located in the pectoral (chest) region. Major and
Pectoralis Major
minor tell us that the pectoralis major is larger than Origin (Proximal/Medial Attachment)
the pectoralis minor. Q Medial clavicle, sternum, and the costal cartilages of
Derivation: ribs one through seven
pectoralis: L. refers to the chest Insertion (Distal/Lateral Attachment)
major: L. larger Q Lateral lip of the bicipital groove of the humerus
minor: L. smaller
Pectoralis Minor
Origin (Proximal/Anterior Attachment)
Q Ribs three through five
Insertion (Distal/Posterior Attachment)

Q Coracoid process of the scapula
3. To palpate the clavicular head, place palpating

ACTIONS finger pads just inferior to the medial clavicle. Ask
the client to move the arm obliquely between flexion
Pectoralis Major and adduction against resistance and feel for the
The pectoralis major moves the arm at the gleno- contraction of the clavicular head; palpate toward the
humeral joint and moves the scapula at the scapulo- distal attachment (Figure 6-13, B)
costal joint.
Q Adducts the arm (entire muscle).
Q Medially rotates the arm (entire muscle). Pectoralis Minor
Q Flexes the arm (clavicular fibers). 1. Client is supine with the hand under the body in the
Q Extends the arm (sternocostal fibers). small of the back or seated with the hand in the small
Q Protracts the scapula. of the back. Place palpating finger pads just inferior to 6
the coracoid process of the scapula.
PECTORALIS MAJOR STABILIZATION 2. Ask the client to press the hand and forearm
down against the table if supine or move the hand
1. Stabilizes the glenohumeral joint. posteriorly away from the small of the back if seated;
2. Stabilizes the shoulder girdle. feel for the contraction of the pectoralis minor through
the pectoralis major (Figure 6-14, A-B).
3. Palpate to the rib attachments, strumming
Pectoralis Minor perpendicular to the fibers.
The pectoralis minor moves the scapula at the scapulo-

costal joint and moves the ribs at the sternocostal and
costospinal joints.
Q Protracts the scapula.
Q Depresses the scapula.
Q Downwardly rotates the scapula.
Q Elevates ribs three through five.
PECTORALIS MINOR STABILIZATION

2. Stabilizes ribs three through five.
A
INNERVATION
Q Medial and lateral pectoral nerves
Note: The medial and lateral pectoral nerves innervate both

the pectoralis major and minor.
PALPATION
Pectoralis Major
1. Client is supine with the arm resting at the side. B
2. To palpate the sternocostal head, place palpating
finger pads over the lower aspect of the anterior FIGURE 6-13 Palpation of the right pectoralis major. A, Palpation
axillary fold of tissue. Ask the client to adduct the of the sternocostal head is demonstrated as the client performs
arm against resistance and feel for the contraction adduction against resistance. B, Palpation of the clavicular
head is demonstrated as the client performs an oblique plane
of the sternocostal head; palpate toward its proximal
motion of flexion and adduction against resistance.
(medial) attachment (Figure 6-13, A).
Turn page to 'more.

Q If the pectoralis muscles are tight, they pull the shoulder
girdle into protraction,
causing the postural
condition known as
rounded/slumped
shoulders.
Q The brachial plexus
of nerves and the
subclavian artery and
vein are sandwiched
between the pecto-
6 A ralis minor and the
rib cage. Therefore
this region is a
common entrapment site for these nerves and blood
vessels. If the pectoralis minor is tight, then these vessels
and nerves may be compressed and the condition is called
pectoralis minor syndrome—one of the three types of
thoracic outlet syndrome.
Q A tight pectoralis minor, by rounding the shoulders, can
also contribute to the clavicle dropping toward the first
rib, causing compression of the brachial plexus of nerves
and subclavian artery and vein. This occurrence is called
costoclavicular syndrome—one of the three types of
thoracic outlet syndrome.
FIGURE 6-14 A, Palpation of the right pectoralis minor is

perpendicular to the fibers as the client presses the hand and
forearm down against the table. B, Having the client seated is
the easiest position for palpating the pectoralis minor, because
the client can comfortably place the hand in the small of the
B back and move it posteriorly when asked to do so.
Detour to Subclavius
Pronunciation sub-KLAY-vee-us
The subclavius is a small muscle located between the clavicle

and first rib, deep to the pectoralis major (Figure 6-15).
Subclavius
STABILIZATION
I Stabilizes the clavicle and first rib.
6
O INNERVATION
Q Nerve from the brachial plexus
PALPATION
1. Client is supine with the arm adducted and resting on
the chest.
2. Curl the palpating fingers around the clavicle so that
the finger pads are on the inferior surface of the
FIGURE 6-15 Anterior view of the right subclavius. The pectoralis clavicle; feel for the subclavius (Figure 6-16).
major has been ghosted in. O, Origin; I, insertion.
3. To palpate while engaged, ask the client to depress
the shoulder girdle; feel for the contraction of the
subclavius.
WHAT’S IN A NAME?
The name, subclavius, tells us that this muscle is
under (inferior to) the clavicle. TREATMENT CONSIDERATION
Derivation Q If the subclavius is tight, it can pull the clavicle and first rib
sub: L. under toward each other, causing compression of the brachial
clavius: L. key plexus of nerves and the subclavian artery and vein. This
condition is called costoclavicular syndrome—one of the
three types of thoracic outlet syndrome.
ATTACHMENTS
Origin (Proximal/Inferior Attachment)
Q First rib
Insertion (Distal/Superior Attachment)

Q Clavicle
ACTIONS
The subclavius moves the clavicle at the sternoclavicu-
lar joint and moves the first rib at the sternocostal and
costospinal joints.
Q Depresses the clavicle. FIGURE 6-16 Palpation of the right subclavius is visualized as
the client depresses the shoulder girdle.
Q Elevates the first rib.

Latissimus Dorsi (Lat); Teres Major
Pronunciation LA 4)3 I MUS$//2 SI s 4% REEZ-!9 JOR
The latissimus dorsi commonly known as the lat, is a broad flat

superficial muscle of the back that attaches to the arm. The teres
major, often referred to as the lat’s helper, is a thick round muscle
that runs parallel to the lat. Together, they form the posterior
6 axillary fold of tissue that borders the axilla (armpit) posteriorly
(Figure 6-17). In the armpit, the teres major is deep to the lat.
I
Teres major
O
O B
A O
FIGURE 6-17 A, Posterior view of the right latissimus dorsi. B,
Posterior view of the right teres major. The deltoid has been ghosted
in. C, Anterior view of the right teres major. O, Origin; I, insertion. C
WHAT’S IN A NAME? STABILIZATION

1. Both muscles stabilize the glenohumeral joint and
The name, latissimus dorsi, tells us that this muscle
scapula.
is a wide muscle of the back. The name, teres major,
tells us that this muscle is round and larger than the 2. The latissimus dorsi also stabilizes the spinal joints
teres minor. and pelvis.
Derivation
latissimus: L. wide
dorsi: L. of the back INNERVATION
teres: L. round
major: L. larger
Q Thoracodorsal nerve (latissimus dorsi)
Q Lower subscapular nerve (teres major)
6
ATTACHMENTS PALPATION
Latissimus Dorsi Latissimus Dorsi

1. The client is prone with the arm relaxed at the side.
Origin (Proximal Attachment) Place the palpating fingers pads on the posterior
Q Inferior angle of the scapula, spinous processes of axillary fold of tissue.
T7-L5, posterior sacrum, and the posterior iliac crest 2. Ask the client to extend the arm; feel for the
contraction of the latissimus dorsi (Figure 6-18, A).
Insertion (Distal Attachment) 3. Palpate to its proximal attachment on the pelvis; and
Q Medial lip of the bicipital groove of the humerus palpate to its distal tendon attachment in the axilla on
the humerus (Figure 6-18, B).
Note: The latissimus dorsi can also be palpated with the

Teres Major client standing with the arm resting on your shoulder. When
Origin (Proximal Attachment) the client presses down against your shoulder toward
Q Inferior angle and inferior lateral border of the scapula extension and adduction, the latissimus dorsi can be felt
to contract and palpated from attachment to attachment
(Figure 6-18, C-D).
Insertion (Distal Attachment)
Q Medial lip of the bicipital groove of the humerus
ACTIONS
Latissimus Dorsi and Teres Major

The latissimus dorsi and teres major move the arm at
the glenohumeral joint.
Q Extend the arm.
Q Adduct the arm.
Q Medially rotate the arm
FIGURE 6-18 A, Palpation of the right latissimus dorsi is

demonstrated as the client extends the arm against resistance.
Palpation of the latissimus dorsi in the posterior axillary fold is
noted.
Continued
Turn page to 'more.

FIGURE 6-18, cont'd B, Palpation of the humeral attachment at

the medial lip of the bicipital groove of the humerus is visualized.
C, Standing palpation of the right latissimus dorsi. The starting
position shows the client’s the distal arm (just proximal to the
elbow joint) on the shoulder of the therapist. D, Palpation of the
humeral attachment is shown as the client tries to move the arm
obliquely toward extension and adduction against resistance.
D
Teres Major TREATMENT CONSIDERATIONS

1. The client is prone with the arm resting on the table Q Swimming the freestyle stroke (the crawl) involves extension,
and the forearm hanging off the table and located adduction, and medial
between the therapist’s knees; place the palpating rotation of the arm;
finger pads just lateral to the lower aspect of the all three are actions
lateral border of the scapula. of the latissimus dorsi
and teres major.
2. Ask the client to rotate the arm medially at the gleno- Therefore swimmers
humeral joint against the resistance of your knee; feel heavily use these
for the contraction of the teres major (Figure 6-19). muscles. In fact, the
latissimus dorsi is often
3. Continue palpating the teres major distally toward the
called the swimmer’s
humerus. muscle.
6
Q Sometimes the
latissimus dorsi and
teres major blend into
each other.
Q The scapular attachment of the latissimus dorsi is often
absent.
Q The spinal and pelvic attachments of the latissimus dorsi are
all via the thoracolumbar fascia, a layer of fascia that covers
the deeper muscles of the thoracic and lumbar regions. The
thoracolumbar fascia is especially thick in the lumbar region,
where it divides into layers, investing and enveloping the
deep muscles of the lumbar region and eventually attaching
onto the posterior iliac crest and the spinous and transverse
processes of the lumbar vertebrae.
FIGURE 6-19 Palpation of the right teres major is demonstrated

as the client medially rotates the arm against resistance.
SHOULDER GIRDLE AND ARM: Rotator Cuff Group

Supraspinatus; Infraspinatus; Teres Minor; Subscapularis
Pronunciation 3// PRA SPY .!9 TUS s ). FRA SPY .!9 TUS s 4% REEZ-9 NOR s
SUB SKAP U ,! RIS
The rotator cuff group is composed of four muscles that attach from the scapula
proximally to the tubercles of the humerus distally; they conjoin to form a
cuff on the humerus, hence the name. These muscles are the Supraspinatus,
Infraspinatus, and Teres minor posteriorly and the Subscapularis more
6 anteriorly; they are commonly referred to as the SITS muscles (Figure 6-20). The
rotator cuff muscles are important as stabilizers of the glenohumeral joint.
Supraspinatus Supraspinatus
Teres minor Subscapularis
I I
Infraspinatus B
FIGURE 6-20 A, Posterior view shows the supraspinatus, infraspinatus, and teres minor. The teres
major has been ghosted in. B, Anterior view shows the supraspinatus and subscapularis. The cut
deltoid and pectoralis major have been ghosted in. O, Origin; I, insertion.
WHAT’S IN A NAME?
The name, supraspinatus, tells us that this muscle Derivation
attaches into the supraspinous fossa of the scapula. supraspinatus: L. above the spine (of the scapula)
The name, infraspinatus, tells us that this muscle infraspinatus: L. below the spine (of the scapula)
attaches into the infraspinous fossa of the scapula. teres: L. round
The name, teres minor, tells us that this muscle is minor: L. smaller
round and smaller than the teres major. subscapularis: L. refers to the subscapular fossa
The name, subscapularis, tells us that this muscle
attaches into the subscapular fossa of the scapula.
ATTACHMENTS ACTIONS
Supraspinatus All four rotator cuff muscles move the arm at the
glenohumeral joint.
The belly of the supraspinatus is located deep to the
trapezius and acromion process of the scapula; its dis-
tal tendon is located deep to the deltoid. Supraspinatus
Q Abducts the arm.
Origin (Proximal Attachment) Q Flexes the arm.
Q Supraspinous fossa of the scapula
Insertion (Distal Attachment) Infraspinatus and Teres Minor

Q Greater tubercle of the humerus Q Laterally rotate the arm. 6
Subscapularis
Infraspinatus
Q Medially rotates the arm.
The infraspinatus is a flat muscle located on the pos-
terior scapula. Most of the infraspinatus is deep to the
deltoid. STABILIZATION
All four muscles stabilize the glenohumeral joint.
Origin (Proximal Attachment)
Q Infraspinous fossa of the scapula Isometric Stabilization Function Note: The rotator cuff mus-
cles are extremely important as stabilizers of the humeral
Insertion (Distal Attachment) head at the glenohumeral joint.
Q Greater tubercle of the humerus
INNERVATION
Teres Minor
Q Suprascapular nerve (supraspinatus and
The teres minor is a small round muscle that runs par-
infraspinatus)
allel with the infraspinatus. It is located between the
infraspinatus and teres major. Most of the teres minor Q Axillary nerve (teres minor)
is deep to the deltoid. Q Upper and lower subscapular nerves (subscapularis)

Q Superior lateral border of the scapula PALPATION
Insertion (Distal Attachment) Supraspinatus
Q Greater tubercle of the humerus 1. The client is prone with the arm resting on the table at
the side; place the palpating finger pads just superior
to the spine of the scapula in the supraspinous fossa.
Subscapularis 2. Ask the client to perform a very short range of motion of
The subscapularis is located between the scapula and abduction of the arm (approximately 10 to 20 degrees);
rib cage wall, along with the serratus anterior. Whereas feel for the contraction of the supraspinatus. Gentle
the serratus anterior hugs the rib cage wall, the sub- resistance can be added (Figure 6-21, A).
scapularis hugs along the scapula and humerus.
3. The distal tendon can be palpated deep to the deltoid.
Origin (Proximal Attachment) Locate the acromion process of the scapula and drop
off it just distally and laterally onto the distal tendon of
Q Subscapular fossa of the scapula
the supraspinatus. Strum horizontally across it.
Insertion (Distal Attachment) Note: The supraspinatus can be easily palpated with the
Q Lesser tubercle of the humerus client seated. Ask the client to perform a short range of
motion that is obliquely between abduction and flexion; feel
for the contraction of the supraspinatus (Figure 6-21, B).
Turn page to 'more.

6 A
FIGURE 6-21 Palpation of the right supraspinatus. A, Palpation

of the belly is shown superior to the spine of the scapula.
B, The supraspinatus can also be easily palpated with the
client seated. To engage the supraspinatus, the client per-
forms either a very short range of motion (approximately 10 to
20 degrees) of abduction of the arm at the glenohumeral joint
with the hand in the small of the back (to reciprocally inhibit
the upper trapezius) or a short range of motion (approximately
10 to 20 degrees) of the arm halfway between abduction and
flexion at the glenohumeral joint as seen here. B
A B
FIGURE 6-22 Palpation of the right infraspinatus and teres minor is demonstrated as the client
laterally rotates the arm against resistance of the therapist's knee. A, Palpation of the infraspinatus
is shown. B, Palpation of the teres minor is shown.
Infraspinatus and Teres Minor Palpate the teres minor from the superior lateral
1. The client is prone with the arm resting on the table border of the scapula to the greater tubercle of the
and the forearm hanging off the table and between humerus.
your knees.
2. Ask the client to rotate the arm laterally against the Note: To discern the teres minor from the teres major
resistance of your knee; feel for the contraction of the located inferiorly to it, the teres minor will engage with
muscles (Figure 6-22, A-B). lateral rotation of the arm and the teres major will engage
with medial rotation of the arm.
3. Palpate the infraspinatus from just below the spine of
the scapula to the greater tubercle of the humerus.
Subscapularis TREATMENT CONSIDERATIONS

1. The client is supine with the arm resting on the trunk Q The distal tendon of the supraspinatus
and the other side hand gently holding the elbow of is the most commonly injured
AL LY
tendon of the rotator cuff
HE M I
TH
the side being palpated.
FA
group because it is often
2. Reach under the client’s body with one hand to grip pinched between the
the medial border of the scapula and gently passively acromion process of the
protract the scapula. Place the finger pads of the scapula and the greater
palpating hand against the anterior surface of the tubercle of the humerus.
scapula (Figure 6-23, A). Q A bursa, which is called
3. Ask the client to take in a deep breath; as the client the subacromial and/or
subdeltoid bursa, is
exhales, slowly but firmly press your finger pads in
against the anterior surface of the client’s scapula. To
located between the 6
supraspinatus and the acromion process and deltoid. This
verify that you are on the subscapularis, ask the client bursa is the commonly injured bursa of the shoulder joint.
to rotate the arm medially, which will cause the arm to Q A bursa is usually located between the infraspinatus and the
lift slightly (Figure 6-23, B). glenohumeral joint capsule.
4. Palpate as much of the subscapularis as possible by Q A bursa is usually located between the subscapularis and
gently but firmly pressing in deeper toward the medial the scapula.
border of the scapula.
Q The distal tendons of all four rotator cuff muscles adhere to
the capsule of the glenohumeral joint, which is deep to them.
Q A thick layer of fascia usually overlies the infraspinatus
muscle (see Figure 6-1).
A B
FIGURE 6-23 Palpation of the right subscapularis. A, Palpation of the belly is shown. Note: The
client’s arm is up so that the belly of the muscle is visualized. B, The arm may be down and
resting on the chest as visualized, which shows the client medially rotating the arm to engage
the subscapularis.

Deltoid
Pronunciation $%, TOID
The deltoid is a thick

triangular muscle that
is located over the
glenohumeral joint. It O
is usually divided into
6 three parts: anterior,
middle, and posterior. Anterior deltoid
The entire deltoid is
Middle deltoid
superficial (Figure 6-24).
Posterior deltoid
FIGURE 6-24 Lateral view of the

right deltoid. The proximal end of
the brachialis has been ghosted in.

The name, deltoid, tells us that this muscle has a The deltoid moves the arm at the glenohumeral joint
triangular shape similar to the Greek letter delta (6). and moves the scapula at the glenohumeral and
Derivation scapulocostal joints.
delta: Gr. letter delta (6) Q Entire muscle:
oid: Gr. resemblance Q Abducts the arm.
Q Downwardly rotates the scapula.
Q Anterior fibers also:

ATTACHMENTS Q Flex the arm.
Q Medially rotate the arm.
Origin (Proximal Attachment) Q Horizontally flex the arm.
Q Lateral clavicle, acromion process, and spine of the Q Posterior fibers also:
scapula Q Extend the arm.
Insertion (Distal Attachment) Q Laterally rotate the arm.

Q Horizontally extend the arm.
Q Deltoid tuberosity of the humerus
STABILIZATION 4. To isolate the posterior deltoid, place the palpating

finger pads just inferior to the spine of the scapula,
1. Stabilizes the glenohumeral joint.
resist the client from horizontally extending the arm;
2. Stabilizes the shoulder girdle. feel for the contraction of the posterior fibers
(Figure 6-25, C).
Note: Resistance is added to the distal arm, not the

INNERVATION forearm.
Q Axillary nerve
PALPATION Q The deltoid is often used or 6
overused, stabilizing the
1. The client is seated, and you are standing behind the
arm in a position of flexion
client. or abduction when per-
2. To palpate the entire deltoid, place the palpating forming such activities as
finger pads just distal to the acromion process of the working at a keyboard or
scapula. Resist the client from abducting the arm; feel using a smart phone in
front of the body. For this
for the contraction of the deltoid (Figure 6-25, A).
reason, finding trigger
3. To isolate the anterior deltoid, place the palpating points and taut and tender
finger pads just inferior to the lateral clavicle, resist bands within the muscle
the client from horizontally flexing the arm; feel for the is extremely common.
contraction of the anterior fibers (Figure 6-25, B). Q Tendinitis at the distal attachment of the deltoid occurs often.
A B
FIGURE 6-25 Palpation of the right deltoid. A, Palpation of the

middle deltoid as the client abducts the arm against resistance.
B, Palpation of the anterior deltoid as the client horizontally
flexes the arm against resistance. C, Palpation of the posterior
deltoid as the client horizontally extends the arm against
C resistance.

Coracobrachialis
Pronunciation +/2 A KO "2! KEY !, IS
The coracobrachialis is a slender O

muscle that is located in the axillary
(armpit) region. In anatomic
position, it is deep to the pectoralis
major and anterior deltoid (Figure
6 6-26). Abducting and laterally
rotating the arm exposes this muscle
from the anterior perspective.
FIGURE 6-26 Anterior view of

the right coracobrachialis. The
deltoid and cut pectoralis minor
have been ghosted in. O, Origin;
I, insertion.

The name, coracobrachialis, tells us that this muscle The coracobrachialis moves the arm at the gleno-
attaches to the coracoid process and the brachium humeral joint.
(the arm/humerus). Q Flexes the arm.
Derivation Q Adducts the arm.
coraco: Gr. refers to the coracoid process of the
scapula
brachialis: L. refers to the arm STABILIZATION
1. Stabilizes the glenohumeral joint.
ATTACHMENTS
Q Coracoid process of the scapula INNERVATION
Insertion (Distal Attachment) Q Musculocutaneous nerve
Q Medial shaft of the humerus
PALPATION STEPS TREATMENT CONSIDERATIONS

1. The client is seated with the arm abducted 90 degrees Q Palpation of the coracobrachialis
and laterally rotated, and the forearm is flexed approxi- must be done prudently because
of the presence of the brachial
mately 90 degrees.
artery and the median, ulnar,
2. Place the palpating finger pads on the medial aspect and musculocutaneous nerves.
of the proximal half of the client’s arm. Q The musculocutaneous
3. Resist the client’s horizontal flexion of the arm; feel for nerve pierces through the
the contraction of the coracobrachialis (Figure 6-27). coracobrachialis.
Q The proximal attachment
Note: Resistance is added to the distal arm, not the of the coracobrachialis blends
forearm. with the proximal attachment of
the short head of the biceps brachii. 6
FIGURE 6-27 Palpation of the right coracobrachialis as the client horizontally flexes the arm at the
glenohumeral joint against resistance. The deltoid has been ghosted in.

Biceps Brachii
Pronunciation BY-seps BRAY-key-eye
The biceps brachii O

is a two-headed
muscle that overlies
the anterior arm.
Both of its heads
6 cross the elbow and
glenohumeral joints. Long head
It is superficial except
proximally, where it
Short head
is deep to the deltoid
(Figure 6-28).
I
Bicipital aponeurosis
FIGURE 6-28 Anterior view of the right biceps brachii. The coracobrachialis and cut distal end of
the brachialis have been ghosted in. O, Origin; I, insertion.

The name, biceps brachii, tells us that this muscle The biceps brachii moves the forearm at the elbow and
has two heads and lies over the brachium (the arm). the radioulnar joints and moves the arm at the gleno-
Derivation humeral joint.
biceps: L. two heads Q Flexes the forearm (elbow joint).
brachii: L. of the arm Q Supinates the forearm (radioulnar joints).
Q Flexes the arm.
ATTACHMENTS STABILIZATION
1. Stabilizes the elbow, radioulnar, and glenohumeral
Origin (Proximal Attachment) joints.
Q Long head: Supraglenoid tubercle of the scapula
Q Short head: Coracoid process of the scapula
Insertion (Distal Attachment) INNERVATION

Q Radial tuberosity and fascia at the medial elbow Q Musculocutaneous nerve
PALPATION STEPS
1. The client is seated with the arm relaxed and the
forearm fully supinated and resting on the client’s
thigh (not shown). Place palpating finger pads on the
middle of the anterior arm.
2. With mild-to-moderate force, resist the client from
flexing the forearm; feel for the contraction of the
biceps brachii (Figure 6-29).
3. Strumming perpendicular to the fibers, first palpate
to the distal tendon on the radius and then palpate
toward the proximal attachments as far as possible.
6
Note: Resistance is added to the distal forearm, not the
hand.
Q Tendinitis of the long head of the
biceps brachii occurs fairly often.
Q The proximal attachment
of the short head of the
biceps brachii blends with
the proximal attachment of
the coracobrachialis at the
coracoid process of the FIGURE 6-29 Palpation of the right biceps brachii is shown
scapula. as the client flexes the forearm at the elbow joint against
resistance.

Brachialis
Pronunciation "2!9 KEY !, IS
The brachialis is
a thick muscle of
the arm. From the
anterior perspective,
it is located deep to
6 the biceps brachii;
however, much of
the brachialis is
superficial from the
lateral perspective
(Figure 6-30). O
FIGURE 6-30 Anterior view

of the right brachialis. The
coracobrachialis and distal
cut end of the deltoid have
been ghosted in. O, Origin; I
I, insertion.

Stabilizes the elbow joint.
The name, brachialis, tells us that this muscle
attaches to the brachium (the arm).
Derivation
brachialis: L. refers to the arm
INNERVATION
Q Musculocutaneous nerve
ATTACHMENTS
PALPATION STEPS
Q Distal one half of the anterior shaft of the humerus 1. The client is seated with the arm relaxed, and the
forearm is fully pronated and resting on the client’s
Insertion (Distal Attachment) thigh (not shown). Place the palpating finger pads
Q Ulnar tuberosity on the lateral side of the distal arm (slightly toward
the anterior side, immediately posterior to the biceps
brachii).
ACTIONS
2. With gentle force, resist the client from flexing the
The brachialis moves the forearm at the elbow joint. forearm with the forearm fully pronated; feel for the
Q Flexes the forearm. contraction of the brachialis (Figure 6-31).
3. Strumming perpendicular to the fibers, palpate the

lateral side of the brachialis to its proximal attachment
and then to its distal attachment. Follow the same
procedure to palpate the brachialis through the
relaxed biceps brachii.
Note: Resistance is gentle and added to the distal forearm,

not to the hand.
Q The brachialis is a strong 6
and fairly large muscle,
which accounts for much
of the contour of the
biceps brachii being so
visible. “Behind every
great biceps brachii is a
great brachialis.”
FIGURE 6-31 Palpation of the right brachialis as the client is

gently resisted from flexing the forearm at the elbow joint, with
the forearm in a fully pronated position.

Triceps Brachii
Pronunciation 429 SEPS"2!9 KEY EYE
The triceps brachii is a large three-headed muscle of the posterior

arm. All three of its heads cross the elbow joint; only the long
head crosses the glenohumeral joint. It is superficial except
proximally where it is deep to the posterior deltoid (Figure 6-32).
6
Lateral head (cut)
O
O
Long head
Lateral head Medial

head
Medial head
Long head
Lateral head (cut)
II
A B
FIGURE 6-32 Posterior views of the right triceps brachii. A, Superficial view. The deltoid has been
ghosted in. B, The lateral head has been cut to show the medial head. The anconeus has been

The name, triceps brachii, tells us that this muscle Origin (Proximal Attachment)
has three heads and attaches to the brachium (the
Q Long head: Infraglenoid tubercle of the scapula
arm/humerus).
Q Lateral head: Posterior shaft of the humerus
Derivation
triceps: L. three heads Q Medial (deep) head: Posterior shaft of the humerus
brachii: L. of the arm
Q Olecranon process of the ulna
ACTIONS
The triceps brachii moves the forearm at the elbow
joint and moves the arm at the glenohumeral joint.
Q Extends the forearm.
Q Extends the arm (long head).
STABILIZATION
1. Stabilizes the elbow and glenohumeral joints.
6
INNERVATION
Q Radial nerve
PALPATION
1. The client is seated with the arm relaxed and hanging
vertically, and the forearm resting on the client or
therapist’s thigh. Place the palpating finger pads on
the posterior surface of the arm.
2. Ask the client to extend the forearm by pressing the
forearm against the thigh; feel for the contraction of
the triceps brachii (Figure 6-33).
3. Strumming perpendicular to the fibers, first palpate
to the distal attachment and then palpate as far
proximally as possible.
4. The triceps brachii can also be easily palpated with FIGURE 6-33 Palpation of the belly of the right triceps brachii
is demonstrated as the client extends the forearm against
the client prone with the arm resting on the table and
resistance.
the forearm hanging off the side of the table.
Q The radial nerve runs between
the medial and lateral
heads of the triceps brachii. CUT!!
Because of its location here,
the radial nerve is often injured.
Q The medial head of the
triceps brachii is the most
active of the three heads,
which means that it is
engaged most often by the
nervous system; however,
the lateral head is the strongest.

Anconeus
Pronunciation AN +/ NEE US
The anconeus is a small muscle

located at the posterior elbow
(Figure 6-34).
I
FIGURE 6-34 Posterior view of the right anconeus.
The triceps brachii has been cut and ghosted in.
STABILIZATION
WHAT’S IN A NAME?
Stabilizes the ulna and elbow joint.
The name, anconeus, tells us that this muscle is
involved with the elbow. Stabilization Function Note: Some sources state that the
Derivation major function of the anconeus is to stabilize the ulna when
anconeus: Gr. elbow the forearm is pronating.
ATTACHMENTS
INNERVATION
Origin (Proximal Attachment) Q Radial nerve
Q Lateral epicondyle of the humerus

Q Posterior proximal ulna PALPATION
1. With the client seated, locate the point halfway
ACTIONS between the olecranon process of the ulna and the
lateral epicondyle of the humerus, and then place
The anconeus moves the forearm at the elbow joint. your palpating finger pads approximately 1/2 inch
Q Extends the forearm. distal to that point.
2. Ask the client to extend the forearm at the elbow

joint against resistance; feel for the contraction of the
anconeus (Figure 6-35).
3. Palpate the entirety of the anconeus.
Q Because the anconeus
attaches to the lateral
epicondyle of the
humerus, it can be
involved in tennis elbow, 6
which is also known
as lateral epicondylitis
or lateral epicondylosis.
FIGURE 6-35 Palpation of the right anconeus is visualized as

the client extends the forearm against resistance.
REVIEW QUESTIONS
Circle or fill in the correct answer for each of the following questions. More study resources, including audio pronunciations
of muscle names, are provided on the Evolve website at http://evolve.elsevier.com/Muscolino/knowthebody.
1. Which of the following muscles can both elevate 6. Which of the following is a glenohumeral joint
and depress the scapula at the scapulocostal action of the subscapularis?
joint? a. Lateral rotation
a. Rhomboids b. Medial rotation
b. Trapezius c. Flexion
c. Levator scapulae d. Adduction
d. Subscapularis
6 7. Which of the following muscles is antagonistic to
2. What muscle attaches from the distal one half the supraspinatus?
of the anterior shaft of the humerus to the ulnar a. Pectoralis major
tuberosity? b. Teres minor
a. Biceps brachii c. Brachialis
b. Coracobrachialis d. Rhomboids
c. Brachialis
d. Triceps brachii 8. Name the four muscles of the rotator cuff group.
3. Which one of the following muscles can supinate ________________________________________________

the forearm at the radioulnar joints?
a. Brachialis ________________________________________________
b. Coracobrachialis
c. Biceps brachii ________________________________________________
d. Anconeus
________________________________________________
4. What muscles attach to the lateral clavicle,
acromion process, and spine of the scapula? 9. What muscle attaches from the scapula to ribs one
a. Deltoid and coracobrachialis through nine?
b. Trapezius and serratus anterior
c. Serratus anterior and latissimus dorsi ________________________________________________
d. Trapezius and deltoid
10. What muscle can both flex and extend the arm at
5. Which of the following is an action of the pectoralis the glenohumeral joint?
minor?
a. Retraction of the scapula at the scapulocostal joint ________________________________________________
b. Flexion of the arm at the glenohumeral joint
c. Abduction of the arm at the glenohumeral joint
d. Protraction of the scapula at the scapulocostal joint
CASE STUDY 1
A client arrives for a massage therapy session with mild QUESTIONS
pain in the anterior left arm. The client is a 42-year-old man
in good shape with no pathologic history or prior injury to 1. Why did the MVA cause arm pain?
the arm. The pain is mild and located directly distal to the
______________________________________________________
glenohumeral (GH) joint in the anterior deltoid muscle. On a
pain scale of 0 to 10, the intensity is approximately 3 when at ______________________________________________________
rest and approximately 6 with exertion.
Verbal history reveals that the client was involved in a ______________________________________________________
motor vehicle accident (MVA) 6 months earlier. The client
______________________________________________________
was the driver; he hit a vehicle in front of him that was
6
stopped at a red light. The client was wearing a seat belt at ______________________________________________________
the time of the accident and had his left hand on the steering
wheel. Damage to the vehicle was minor; the air bag did not ______________________________________________________
deploy. The client saw his personal physician who ordered ______________________________________________________
a magnetic resonance image (MRI) of the arm; the MRI
report was negative for osseous damage. His physician 2. What treatment would be most beneficial for this
also ordered a minor analgesic medication to be taken as client?
needed for the soft-tissue pain. No physical therapy was
prescribed. The client’s pain was more intense immediately ______________________________________________________
after the accident, but it decreased to the present level
______________________________________________________
within approximately 3 months; it has remained at this level
since then. ______________________________________________________
A physical examination revealed that active range of
motion (ROM) of the GH joint into flexion is limited to 120 ______________________________________________________
degrees. Active and passive ROM of the GH joint into
______________________________________________________
extension is limited to 30 degrees. Manual resistance to
GH joint flexion reveals reduced muscle strength and pain ______________________________________________________
starting at approximately 45 degrees with total loss of
strength at 120 degrees. Pain reaches an intensity of 6 at ______________________________________________________
120 degrees. Palpatory assessment revealed tightness and ______________________________________________________
adhesions in the anterior deltoid, pectoralis major and minor,
biceps brachii, and coracobrachialis muscles. ______________________________________________________
CASE STUDY 2
A female client, age 34 years, well toned, and an active QUESTIONS
offshore competitive swimmer, complains of pain and
decreased range of motion of her right shoulder. Her 1. What activities could have caused the recent change?
condition began approximately 1 week earlier. The client
______________________________________________________
describes an inability to raise her arm fully to the side of her
body and reports that she is experiencing a pain intensity ______________________________________________________
that varies from 2 to 5 on a scale of 0 to 10. She points to the
right anterior glenohumeral joint region as the site of maximal ______________________________________________________
pain. The pain and stiffness are most acute when she first
______________________________________________________
starts working out and also in the mornings when she first
6
wakes up. She states that the range of motion increases after ______________________________________________________
her workout but not fully; and that the pain is reduced to a
2 after her workout. She has been applying heat after her ______________________________________________________
workouts and taking ibuprofen for pain: 200 mg, two times a
day, for the last 5 days with little noticeable benefit. The client 2. What treatment plan would you recommend?
states that she has not experienced any traumatic injuries,
______________________________________________________
accidents, or other pathologic issues.
This client has been an active swimmer for 2 years; ______________________________________________________
her training consists of local pool workouts with a Swim
Masters coach 2 days each week and open-water swims ______________________________________________________
with competitors 2 days per week. The Swim Masters coach
______________________________________________________
has noticed a change in her right arm stroke during her last
two workouts. He can see that she is not lifting her right arm ______________________________________________________
completely out of the water but is, instead, dragging it across
the top of the water. In open-water training the client notices ______________________________________________________
that her right arm does not seem to manage wave impacts ______________________________________________________
as effectively as her left arm. Two weeks earlier, she added
three weight training sessions to her weekly regimen.
3. What self-care would you recommend?
Palpation during physical examination produces a pain
intensity of 5 to 7 in the shoulder joint from the superior angle ______________________________________________________
of the scapula to the head of the humerus anteromedially.
Moderate muscle spasm is present diffusely throughout the ______________________________________________________
entire right shoulder region, but it is strongest in the upper
______________________________________________________
trapezius, supraspinatus, and anterior deltoid muscles. The
client is very vigilant and noticeably guards herself when ______________________________________________________
she fears that pain will occur. Mild swelling is present in the
tissues around the glenohumeral joint. Manual muscle testing ______________________________________________________
against resistance for all glenohumeral joint ranges of motion ______________________________________________________
causes a pain intensity of 5 to 8.
CHAPTER
Muscles of the Forearm
and Hand 7
CHAPTER OUTLINE
Overview of Function: Muscles of the Elbow Extensors Digitorum and Digiti Minimi, 214
and Radioulnar Joints, 182 Extensor Digitorum
Overview of Function: Muscles of the Wrist Extensor Digiti Minimi
Joint, 182
Supinator, 216
Overview of Function: Muscles of the Fingers, 183
Deep Distal Four Group, 218
FOREARM/EXTRINSIC HAND MUSCLES Abductor Pollicis Longus
Wrist Flexor Group, 198 Extensor Pollicis Brevis
Flexor Carpi Radialis Extensor Pollicis Longus
Palmaris Longus Extensor Indicis
Flexor Carpi Ulnaris
INTRINSIC HAND MUSCLES
Pronator Group, 202 Thenar Eminence Group, 222
Pronator Teres Abductor Pollicis Brevis
Pronator Quadratus Flexor Pollicis Brevis
Brachioradialis, 204 Opponens Pollicis
Flexors Digitorum and Pollicis Group, 206 Hypothenar Eminence Group, 226
Flexor Digitorum Superficialis Abductor Digiti Minimi Manus
Flexor Digitorum Profundus Flexor Digiti Minimi Manus
Flexor Pollicis Longus Opponens Digiti Minimi
Wrist Extensor Group, 210 Palmaris Brevis, 230
Extensor Carpi Radialis Longus Central Compartment Group, 232
Extensor Carpi Radialis Brevis Adductor Pollicis
Extensor Carpi Ulnaris Lumbricals Manus
Palmar Interossei
Dorsal Interossei Manus
T he muscles of this chapter are involved with

motions of the forearm (radius and ulna) at the
radioulnar joints, the hand at the wrist (radiocarpal)
Forearm muscles are usually divided into an
anterior flexor compartment and a posterior extensor
compartment. The flexor compartment has three lay-
joint, and the fingers at the metacarpophalangeal ers: superficial, intermediate, and deep. The extensor
(MCP) and/or the proximal interphalangeal (PIP) and compartment has two layers: superficial and deep. A
distal interphalangeal (DIP) joints; the thumb also third group, called the radial group (also known as the
moves at the first carpometacarpal (CMC) (saddle) wad of three), is sometimes designated. It consists of
joint. the brachioradialis of the anterior compartment and the
181
extensors carpi radialis longus and brevis of the poste- A structure of importance in the hand is the dor-
rior compartment. sal digital expansion. The dorsal digital expansion is a
Two other structures of importance in the forearm fibrous expansion of the extensor digitorum and exten-
are the common flexor tendon and the common extensor pollicis longus muscles' distal tendons on the dor-
sor tendon. The common flexor tendon attaches to the sal side of the fingers (digits).
medial epicondyle of the humerus. Five muscles attach As a general rule, muscles that move the elbow
into the common flexor tendon: (1) flexor carpi radialis, joint have their origin (proximal attachment) on the arm
(2) palmaris longus, (3) flexor carpi ulnaris, (4) pronator (humerus) and their insertion (distal attachment) on the
teres, and (5) flexor digitorum superficialis. The com- forearm (radius or ulna) or hand. Muscles that pronate
mon extensor tendon attaches to the lateral epicondyle or supinate the forearm usually have their origin (proxi-
of the humerus. Four muscles attach into the com- mal attachment) on the radius and their insertion (distal
mon extensor tendon: (1) extensor carpi radialis brevis, attachment) on the ulna. Muscles that move the wrist
(2) extensor digitorum, (3) extensor digiti minimi, and joint usually have their origin (proximal attachment) on
(4) extensor carpi ulnaris. the arm or forearm and their insertion (distal attachment)
7 Muscles that move the fingers are often divided on the hand. Finger muscles may be extrinsic or intrinsic
into extrinsic and intrinsic hand/finger muscles. Intrinsic as previously discussed.
hand muscles are wholly located within the hand; As a rule, flexor and pronator muscles attach to
in other words, they originate and insert within the the medial epicondyle of the humerus via the common
hand. Intrinsic muscles on the palmar side of the flexor tendon.
hand can be divided into three groups: (1) thenar emi- As a rule, extensor and supinator muscles attach
nence, (2) hypothenar eminence, and (3) central to the lateral epicondyle of the humerus via the com-
compartment. mon extensor tendon.
Extrinsic finger muscles have their origin (proxi- The companion CD at the back of this book allows
mal attachment) outside of the hand, in the forearm or you to examine the muscles of this body region, layer
arm. Because they also cross the wrist and/or elbow by layer, and individual muscle palpation technique
joints, they can also move those joints. videos are available in the Chapter 7 folder on Evolve.
OVERVIEW OF FUNCTION: MUSCLES Q If a muscle crosses the radioulnar joints posteriorly

with a horizontal direction to its fibers, it will supi-
OF THE ELBOW AND RADIOULNAR nate the forearm at the radioulnar joints by moving
JOINTS the radius to be parallel with the ulna.
Q Reverse actions of these standard mover actions at the
The following general rules regarding actions can be
radioulnar joints involve moving the ulna toward the
stated for the functional groups of the muscles of the
radius at the radioulnar joints. This movement usu-
elbow and radioulnar joints.
ally occurs when the hand (and therefore the radius)
Q If a muscle crosses the elbow joint anteriorly with a
is fixed by holding onto an immovable object.*
vertical direction to its fibers, it can flex the forearm
at the elbow joint by moving the anterior surface of
the forearm toward the anterior surface of the arm.
Q If a muscle crosses the elbow joint posteriorly with OVERVIEW OF FUNCTION: MUSCLES
a vertical direction to its fibers, it can extend the OF THE WRIST JOINT
forearm at the elbow joint by moving the posterior
surface of the forearm toward the posterior surface The following general rules regarding actions can be
of the arm. stated for the functional groups of the muscles of the
Q Reverse actions at the elbow joint involve mov- wrist joint:
ing the arm toward the forearm at the elbow joint. Q If a muscle crosses the wrist joint anteriorly with a
This movement usually occurs when the hand (and vertical direction to its fibers, it can flex the hand
therefore the forearm) is fixed by holding onto an at the wrist joint by moving the palmar (anterior)
immovable object.* surface of the hand toward the anterior surface of
Q If a muscle crosses the radioulnar joints anteriorly the forearm.
with a horizontal orientation to its fibers, it will Q If a muscle crosses the wrist joint posteriorly with a
pronate the forearm at the radioulnar joints by vertical direction to its fibers, it can extend the hand
crossing the radius over the ulna. at the wrist joint by moving the dorsal (posterior)
Chapter 7 Muscles of the Forearm and Hand 183
surface of the hand toward the posterior surface of Q The thumb (finger one) can move at three joints:
the forearm. the CMC, MCP, and interphalangeal (IP) joints.
Q If a muscle crosses the wrist joint on the radial side Similarly, a muscle can only move the thumb at a
(laterally) with a vertical direction to its fibers, it joint or joints that it crosses.
can radially deviate (abduct) the hand at the wrist Q If a muscle crosses the MCP, PIP, or DIP joints of
joint by moving the radial side of the hand toward fingers two through five on the anterior side, it can
the radial side of the forearm. flex the finger at the joint(s) crossed; if a muscle
Q If a muscle crosses the wrist joint on the ulnar side crosses the MCP, PIP, or DIP joints of fingers two
(medially) with a vertical direction to its fibers, it through five on the posterior side, it can extend the
can ulnar deviate (adduct) the hand at the wrist finger at the joint(s) crossed.
joint by moving the ulnar side of the hand toward Q If a muscle crosses the MCP joint of fingers two,
the ulnar side of the forearm. four, or five on the side that faces the middle finger,
Q Reverse actions of these standard mover actions it can adduct the finger at the MCP joint. If a mus-
involve the forearm being moved toward the hand cle crosses the MCP joint of fingers two, three, or
at the wrist joint. These reverse actions usually four on the side that is away from the middle finger 7
occur when the hand is fixed, such as when hold- side, it can abduct the finger at the MCP joint (the
ing onto an immovable object.* middle finger abducts in both directions—radial
and ulnar).
Q Muscles that cross the CMC, MCP, and IP joints
OVERVIEW OF FUNCTION: MUSCLES of the thumb on the medial side can flex the
thumb at the joint(s) crossed. Muscles that cross
OF THE FINGERS the CMC, MCP, and IP joints of the thumb on the
The following general rules regarding actions can be lateral side can extend the thumb at the joint(s)
stated for the functional groups of finger muscles: crossed.
Q Fingers two through five can move at three joints: Q Muscles that cross the CMC joint of the thumb
(1) MCP, (2) PIP, and (3) DIP joints. If a muscle on the anterior side can abduct the thumb at the
crosses only the MCP joint, it can move the finger CMC joint. Muscles that cross the CMC joint of the
only at the MCP joint. If the muscle crosses the MCP thumb on the posterior side can adduct the thumb
and PIP joints, it can move the finger at both of at the CMC joint.
these joints. If the muscle crosses the MCP, PIP, and Q Reverse actions involve the proximal attachment
DIP joints, it can move the finger at all three joints. moving toward the distal attachment. This move-
ment occurs when the fingers are holding onto a
Note: The little finger can also move at the CMC joint. fixed, immovable object.*
*A standard (typical) mover action is when the insertion (distal attachment) moves toward
the origin (proximal attachment). A reverse mover action occurs when the origin moves
toward the insertion.
Anterior View
of the Muscles
of the Right Wrist Joint—
Superficial View
Medial epicondyle of humerus
Pronator teres
7
Brachioradialis
Palmaris longus Wrist

flexor group
Extensor carpi radialis longus Flexor digitorum superficialis
Abductor pollicis longus Flexor digitorum profundus
Pronator quadratus Palmar carpal ligament
Transverse carpal ligament

Radial styloid (flexor retinaculum)
FIGURE 7-1 A, Anterior view of the muscles of the right wrist joint—superficial view.
184
Anterior View
of the Muscles
Intermediate View
Brachioradialis (cut) Medial epicondyle of humerus
Wrist flexor group (cut)

Pronator teres (cut)
7
Supinator
Pronator teres (cut)

Pronator quadratus
Radial styloid

(flexor retinaculum)

FIGURE 7-1, cont'd B, Anterior view of the muscles of the right wrist joint—intermediate view.
Continued
185
Anterior View
of the Muscles
Shaft of humerus
Deep View
Lateral epicondyle of humerus Flexor digitorum superficialis (cut)
Pronator teres (ulnar head) (cut)
7
Radius
Flexor digitorum superficialis (cut)
Pronator quadratus

(cut and reflected)
C
FIGURE 7-1, cont'd C, Anterior view of the muscles of the right wrist joint—deep view. The
brachialis (cut) has been ghosted in.
186
Posterior View
of the Muscles
Superficial View
Brachioradialis
Medial epicondyle of humerus Lateral epicondyle of humerus
Olecranon process of ulna
Anconeus
7
(ECRL)

(ECRB)
Flexor carpi ulnaris Extensor digitorum
Extensor carpi ulnaris Extensor digiti minimi
Extensor indicis
ECRL tendon
ECRB tendon
A
FIGURE 7-2 A, Posterior view of the muscles of the right wrist joint—superficial view.
Continued
187
Posterior View
of the Muscles
Brachioradialis
of the Right
Wrist Joint— Extensor carpi radialis longus (ECRL) (cut)
Deep Views
Lateral epicondyle of humerus
Medial epicondyle Extensor carpi radialis brevis (ECRB) (cut)

of humerus
Olecranon process of ulna

Supinator Interosseus membrane
7
Ulna
Radius
EPB
ECRB (cut)
ECRL (cut) Extensor indicis
Abductor
pollicis
longus
Extensor pollicis longus (EPL)
Extensor
Extensor indicis pollicis
brevis (EPB)
Ulnar styloid
C
ECRL tendon
ECRB tendon
Extensor digitorum
tendon to index finger
(cut)
FIGURE 7-2, cont'd B, C, Posterior view of the muscles of the right wrist joint—deep views.
188
Medial View of the
Muscles of the Right
Wrist Joint

Pronator teres
Palmaris longus Wrist flexor group 7
Flexor digitorum superficialis (FDS)

Extensor digitorum
Extensor digiti minimi
Flexor digitorum profundus (FDP)
Ulna
1st metacarpal
5th metacarpal
Pisiform
FDS tendons
FDP tendons
A
FIGURE 7-3 A, Medial view of the muscles of the right wrist joint.
Continued
189
Lateral View
of the Muscles of the
Right Wrist Joint
Lateral epicondyle of humerus
Brachioradialis
Extensor carpi radialis
longus (ECRL)
Radial group
7
Extensor digiti minimi Extensor carpi radialis
brevis (ECRB)
Extensor digitorum

ECRB tendon
Radius
ECRL tendon
1st metacarpal
FIGURE 7-3, cont'd B, Lateral view of the muscles of the right wrist joint.
190
Cross Section of the Right
Middle Forearm
in the Transverse Plane
Palmaris longus Flexor digitorum superficialis
Median nerve Flexor carpi radialis
Brachioradialis
Ulnar nerve and artery
7
Superficial branch of
radial nerve and artery
Flexor carpi
ulnaris Extensor carpi
radialis longus
Radius
Flexor pollicis
longus
Ulna
Flexor digitorum Extensor carpi

profundus radialis brevis
Flexor carpi
ulnaris (tendon) Interosseus membrane
Posterior interosseus Abductor pollicis
nerve and artery longus
Extensor pollicis Extensor Extensor digiti Extensor digitorum

longus carpi ulnaris minimi
FIGURE 7-4 Transverse plane cross section of the right middle forearm.
191
Anterior (Palmar) View Brachioradialis
of the Musculature Palmaris longus
of the Right Hand Flexor carpi ulnaris
Abductor pollicis longus Pronator quadratus

Ulna
7
Radius

OP
Palmaris brevis
APB
Palmar aponeurosis
FPB
ADMM
Adductor pollicis
FDMM
Flexor
pollicis longus
1st DIM
Flexor
digitorum
Lumbricals manus superficialis
Flexor digitorum
profundus
FIGURE 7-5 A, Superficial view of the hand with the palmar aponeurosis. ADMM, Abductor digiti
minimi manus; APB, abductor pollicis brevis; DIM, dorsal interosseus/interossei manus;
FDMM, flexor digiti minimi manus; FPB, flexor pollicis brevis; OP, opponens pollicis.
192
Anterior (Palmar) View
of the Musculature
of the Right Hand
Extensor carpi radialis longus (cut)

Flexor carpi ulnaris (cut)
Brachioradialis (cut) Pronator quadratus
Abductor pollicis longus (cut)

Ulna
Radius
7
OP
ADMM
APB
FDMM
FPB ODM
Lumbricals manus
Adductor pollicis
PI
1st DIM
2nd, 3rd, 4th DIM
Flexor
digitorum
profundus
FIGURE 7-5, cont'd B, Superficial view of the musculature of the hand with the palmar
aponeurosis removed. ADMM, Abductor digiti minimi manus; APB, abductor pollicis brevis;
DIM, dorsal interosseus/interossei manus; FDMM, flexor digiti minimi manus; FPB, flexor pollicis
brevis; ODM, opponens digiti minimi; OP, opponens pollicis; PI, palmar interossei.
Continued
193
of the Musculature Flexor digitorum profundus
of the Right Hand
Extensor carpi radialis longus (cut) Flexor carpi ulnaris (cut)

Pronator quadratus
Brachioradialis (cut)
Abductor pollicis longus (cut)

Ulna
Radius
(flexor retinaculum) (cut)
7 APB (cut)
FPB (cut)
ADMM (cut)
OP
FDMM (cut)
FPB (cut) ODM
Lumbricals manus
APB (cut)
FDMM (cut)
ADMM (cut)
Adductor pollicis PI
1st DIM
2nd, 3rd, 4th DIM
FIGURE 7-5, cont'd C, Intermediate view with the more superficial thenar and hypothenar
muscles cut. ADMM, Abductor digiti minimi manus; APB, abductor pollicis brevis; DIM, dorsal
interosseus/interossei manus; FDMM, flexor digiti minimi manus; FPB, flexor pollicis brevis;
ODM, opponens digiti minimi; OP, opponens pollicis; PI, palmar interossei.
194
of the Musculature
of the Right Hand
Radius Ulna

(flexor retinaculum) (cut)
APB (cut)
7
ADMM (cut)
FPB (cut)
FDMM (cut)
OP ODM
2nd, 3rd, 4th DIM
FPB (cut)
APB (cut)
FDMM (cut)
ADMM (cut)
Adductor pollicis
PI
1st DIM
Lumbricals manus (cut)

and profundus tendons (cut)
FIGURE 7-5, cont'd D, Deep view with the more superficial thenar and hypothenar muscles,
lumbricals manus, flexor digitorum muscles’ tendons, and all forearm muscles cut and/or
removed. ADMM, Abductor digiti minimi manus; APB, abductor pollicis brevis; DIM, dorsal
interosseus/interossei manus; FDMM, flexor digiti minimi manus; FPB, flexor pollicis brevis;
ODM, opponens digiti minimi; OP, opponens pollicis; PI, palmar interossei.
195
Posterior Extensor digitorum
(Dorsal) View
of the Musculature
of the Right Hand Extensor digiti minimi

Extensor indicis
7
Extensor carpi radialis longus tendon
Scaphoid
Extensor carpi radialis

brevis tendon
2nd dorsal interosseus

Abductor digiti minimi manus
manus (DIM)
3rd DIM Adductor pollicis
4th DIM
1st DIM
Dorsal digital
expansion
FIGURE 7-6 Posterior (dorsal) view of the right hand.
196
Notes
FOREARM AND HAND: Wrist Flexor Group

Flexor Carpi Radialis; Palmaris Longus; Flexor Carpi Ulnaris
Pronunciation &,%+3 OR+!2 PIE2!9 DEE ! LIS s PALL -! RIS,/.' US s
&,%+3 OR+!2 PIEUL .! RIS
The wrist flexor group is composed

of three muscles that all originate
(have their proximal attachment)
on the medial epicondyle of the
humerus via the common flexor
7 tendon. They all cross the wrist joint O
anteriorly; therefore they can all flex
the hand at the wrist joint, hence the
name of the group. These muscles
are the flexor carpi radialis, palmaris
longus, and flexor carpi ulnaris. All
three muscles of the wrist flexor Flexor carpi radialis
group are superficial in the anterior
forearm. At the wrist joint, the Palmaris longus
palmaris longus crosses dead center;
the flexor carpi radialis crosses Flexor carpi ulnaris
slightly to the radial (lateral) side;
and the flexor carpi ulnaris crosses
far to the ulnar (medial) side (Figure
7-7). In addition to the humeral
attachment, the flexor carpi ulnaris
also has an ulnar attachment. The
humeral head is much thicker; the
ulnar head is extremely thin.
FIGURE 7-7 Anterior view of the right wrist

flexor group of muscles. O, Origin; I, insertion.
WHAT’S IN A NAME? Flexor Carpi Ulnaris

The name, flexor carpi radialis, tells us that this The flexor carpi ulnaris is superficial in the anterior
muscle flexes and radially deviates (abducts); carpi forearm and located medial to the palmaris longus.
tells us that these actions occur at the wrist joint.
The name, flexor carpi ulnaris, tells us that this Origin (Proximal Attachment)
muscle flexes and ulnar deviates (adducts) the wrist Q Medial epicondyle of the humerus via the common
joint. flexor tendon, and the ulna
The name, palmaris longus, tells us that this muscle
attaches into the palm of the hand and is long (longer
than the palmaris brevis). Insertion (Distal Attachment)
Derivation: Q Anterior hand on the ulnar side
flexor: L. muscle that flexes a body part
radialis: L. refers to the radial side (of the forearm)
ulnaris: L. refers to the ulnar side (of the forearm) 7
palmaris: L. refers to the palm ACTIONS
longus: L. longer
carpi: L. of the wrist Q All three muscles of the wrist flexor group flex the
hand at the wrist joint.
Q The flexor carpi radialis also radially deviates the hand
at the wrist joint.
Q The flexor carpi ulnaris also ulnar deviates the hand at
ATTACHMENTS the wrist joint.
Flexor Carpi Radialis STABILIZATION

The flexor carpi radialis is superficial in the anterior As a group, the wrist flexor muscles stabilize the wrist,
forearm and located between the pronator teres and elbow, and radioulnar joints.
the palmaris longus.
Stabilization Function Note: The flexor carpi ulnaris also
stabilizes the pisiform bone of the carpal group when the
abductor digiti minimi manus (intrinsic muscle of the hand)
Q Medial epicondyle of the humerus via the common contracts, so that the abductor digiti minimi manus can
flexor tendon efficiently abduct the little finger.

Q Anterior hand on the radial side
INNERVATION
Palmaris Longus Q Median and ulnar nerves
The palmaris longus is superficial in the anterior fore- Note: The median nerve innervates the flexor carpi radialis
arm and located between the flexor carpi radialis and and palmaris longus; the ulnar nerve innervates the flexor
the flexor carpi ulnaris. carpi ulnaris.

Q Medial epicondyle of the humerus via the common
flexor tendon

Q Palm of the hand
Turn page to 'more.

PALPATION
1. The client is seated with the arm relaxed. The forearm
is flexed at the elbow joint and is fully supinated and
resting on the client’s thigh. Place your support/
resistance hand on the client’s hand, just proximal to
the fingers.
2. Resist the client from flexing the hand at the wrist joint
(be sure that you do not contact the fingers when
offering resistance), and look for the distal tendons
of all three wrist flexors to become visible. If they do
not become visible, then they should be palpable by
strumming perpendicularly across them. The flexor
carpi ulnaris is usually the least visible.
7 A
3. Begin by palpating the flexor carpi radialis by
strumming horizontally across it (Figure 7-8). Then
palpate the palmaris longus and flexor carpi ulnaris in
a similar manner.
4. Continue palpating each of these muscles proximally
to the medial epicondyle by strumming across its
fibers.
Note: The flexor carpi radialis can be palpated with resisted

radial deviation of the hand at the wrist joint; similarly, the
flexor carpi ulnaris can be palpated with ulnar deviation.
The palmaris longus can be palpated by asking the client to
“cup the hand” (Figure 7-9). B
FIGURE 7-9 Palpation of the muscles of the right wrist flexor

group. A, Palpation of the flexor carpi radialis as the client
radially deviates the hand against resistance. The palmaris
FIGURE 7-8 All three muscles of the right wrist flexor group are longus has been ghosted in. B, Palpation of the flexor carpi
engaged with flexion of the hand against resistance. The distal ulnaris as the client ulnar deviates the hand against resistance
tendons are often visible as shown. The tendon of the flexor (the palmaris longus has been ghosted in). C, The palmaris
carpi radialis is being palpated. longus is engaged when the client cups his hand.
Q Overuse of the Q In many individuals, palmaris
Where longus
wrist flexor group the palmaris longus is it?
musculature can is bilaterally or
cause irritation unilaterally absent.
and/or inflammation
Q The ulnar nerve
of the medial
passes between
epicondyle and/or
the two heads of
the common flexor
the flexor carpi
tendon. This
ulnaris. Compression
condition is known
of the ulnar nerve
as medial epicondylitis,
between the two heads
medial epicondylosis,
of the flexor carpi ulnaris is
or golfer’s elbow.
called cubital tunnel syndrome.
7
FOREARM AND HAND: Pronator Group

Pronator Teres; Pronator Quadratus
Pronunciation PRO .!9 TOR4% REEZ s PRO .!9 TORKWOD 2!9 TUS
The pronator teres and pronator quadratus muscles

are located in the anterior forearm. The pronator teres
is superficial in the proximal forearm; the pronator
quadratus is very deep in the distal forearm. The pronator
Humeral head
teres has two heads—a large, superficial humeral head
O and a small, deep ulnar head (Figure 7-10).
7 Ulnar head
WHAT’S IN A NAME?
The name, pronator, tells us that these muscles
Pronator teres pronate the forearm. Teres refers to being round in
shape; quadratus refers to being square in shape.
Derivation:
pronator: L. muscle that pronates a body part
teres: L. round
quadratus: L. squared
I
ATTACHMENTS
Pronator Teres
Q Humeral head: Medial epicondyle of the humerus via
O the common flexor tendon
Pronator Q Ulnar head: Coronoid process of the ulna
I quadratus

Q Lateral radius
Pronator Quadratus
Q Anterior distal ulna

Q Anterior distal radius
ACTIONS
Pronator Teres
Q Pronates the forearm at the radioulnar joints.
Q Flexes the forearm at the elbow joint.
FIGURE 7-10 Anterior view. The supinator and brachialis (cut) Pronator Quadratus
have been ghosted in. O, Origin; I, insertion.
STABILIZATION Pronator Quadratus

1. Both pronator muscles stabilize the radioulnar joints. 1. The client is seated or supine with the forearm fully
2. The pronator teres also stabilizes the elbow joint. supinated. Place your palpating finger pads on the
distal forearm, just proximal to the wrist.
Stabilization Function Note: The pronator quadratus is espe-
2. Ask the client to pronate the forearm actively at the
cially important for preventing the separation of the distal
radioulnar joints, and feel for the contraction of the
radius and ulna.
pronator quadratus. Resistance can be added if
necessary (Figure 7-12).
Note: The pronator quadratus is deep and can be difficult
INNERVATION to palpate and discern. Further, the median and ulnar
Q Median nerve
nerves and radial and ulnar arteries are located in
the anterior wrist; prudence must be exercised when
palpating deeply here.
7
PALPATION
Pronator Teres TREATMENT CONSIDERATIONS
1. The client is seated with the arm relaxed and the Q The median nerve courses
forearm flexed at the elbow joint and in a position that between the humeral head
and the ulnar head of the
is halfway between full pronation and full supination;
pronator teres, making it a
the forearm is resting on the client’s thigh. Place possible entrapment site.
your palpating thumb or finger pads on the proximal When the median nerve
anterior forearm, and gently but firmly grasp the is entrapped here, it is
client’s distal forearm just proximal to the wrist joint termed pronator teres
with your support/resistance hand. syndrome and may mimic
symptoms of carpal
2. With moderate force, resist the client from pronating tunnel syndrome or a
the forearm at the radioulnar joints and feel for the pathologic cervical disc.
contraction of the pronator teres (Figure 7-11).
Q Overuse of the pronator teres can cause irritation and/or
3. Strumming perpendicular to the fibers, palpate from inflammation of the medial epicondyle and/or the common
attachment to attachment. Be sure to strum across flexor tendon. This condition is known as medial epicon-
the entire muscle belly. dylitis, medial epicondylosis, or golfer’s elbow.
FIGURE 7-11 Palpation of the right pronator teres as the client FIGURE 7-12 View of the right pronator quadratus being palpated
pronates the forearm at the radioulnar joints against resistance. as pronation of the forearm at the radioulnar joints is resisted.
FOREARM AND HAND

Brachioradialis
Pronunciation BRAY-key-o-RAY-dee-AL-is
The brachioradialis is superficial for its entire course

(except for a small part of its distal tendon that is
deep to two small muscles of the thumb whose
O bellies are located deep in the posterior forearm).
The brachioradialis is located in the anterior forearm
on the radial (lateral) side. Because it is on the radial
7 side, it is considered to be part of the “radial group,”
along with the extensor carpi radialis longus and
extensor carpi radialis brevis (Figure 7-13).
Brachioradialis
WHAT'S IN A NAME?
The name, brachioradialis, tells us that this muscle
attaches onto the brachium (the arm) and the radius.
Derivation:
brachio: L. refers to the arm
radialis: L. refers to the radius
ATTACHMENTS
I Q Lateral supracondylar ridge of the humerus

Q Styloid process of the radius
ACTIONS
The brachioradialis moves the forearm at the elbow
and radioulnar joints.
Q Flexes the forearm at the elbow joint.
Q Supinates the forearm at the radioulnar joints.
Action Note: If the forearm is fully pronated, the brachio-

radialis can supinate it to a position that is halfway between
full pronation and full supination. If the forearm is fully supi-
FIGURE 7-13 Anterior view of the right brachioradialis. The nated, the brachioradialis can pronate it to a position that is
brachialis has been ghosted in. O, Origin; I, insertion. halfway between full pronation and full supination.
STABILIZATION Note: Contacting and adding resistance to the distal forearm,

not the hand, is extremely important. If resistance is added
Stabilizes the elbow and radioulnar joints.
to the hand, then the adjacent extensor carpi radialis longus
will engage, making it difficult to discern the brachioradialis
from this muscle.
INNERVATION
Q Radial nerve
PALPATION
forearm flexed at the elbow joint and in a position that
is halfway between full pronation and full supination; 7
the forearm is resting on the client’s thigh. Place your
support/resistance hand on the client’s anterior distal
forearm, just proximal to the wrist joint.
2. Ask the client to try to flex the forearm with moderate
force against your resistance. First look for the
contraction of the brachioradialis and then feel for
its contraction at the proximal anterolateral forearm
(Figure 7-14).
3. Strumming perpendicular to the fibers, palpate
proximally to the lateral supracondylar ridge of the
humerus and then distally to the styloid process of FIGURE 7-14 Palpation of the right brachioradialis with the
the radius. forearm halfway between full supination and full pronation.
Q The brachioradialis is one of the three Bs of elbow joint
flexion: (1) biceps brachii, (2) brachialis, and (3) brachioradialis.
The biceps brachii flexes best when the forearm is fully
supinated; the brachialis flexes best when the forearm is fully
pronated; the brachioradialis flexes best when the forearm is
halfway between fully supinated and fully pronated.
Q The brachioradialis is sometimes nicknamed the hitchhiker
muscle for the characteristic action of flexing the forearm in
a position halfway between full pronation and full supination
(with the thumb up) when hitchhiking. (Keep in mind that the
brachioradialis has no action on the thumb itself.)
FOREARM AND HAND: Flexors Digitorum and Pollicis Group

Flexor Digitorum Superficialis: Flexor Digitorum Profundus;
Flexor Pollicis Longus
Pronunciation &,%+3 ORDIJ I 4/% RUM3// PER FISH EE ! LIS s
&,%+3 ORDIJ I 4/% RUMPRO &5. DUS s &,%+3 OR0/, I SIS,/.' US
The flexor digitorum superficialis, flexor digitorum profundus, and

flexor pollicis longus are all long, extrinsic flexors of the fingers.
Both flexor digitorum muscles flex fingers 2 through 5; and the
flexor pollicis muscle flexes the thumb (finger 1). These muscles
are considered to be long extrinsic finger muscles because they
7 originate (have their proximal attachment) outside of the hand. The
flexor digitorum superficialis is in the intermediate layer of anterior
forearm muscles, directly deep to the muscles of the wrist flexor
group. The flexor digitorum profundus and flexor pollicis longus
are in the deep layer of the anterior forearm, deep to the flexor
digitorum superficialis (Figure 7-15).
Humeroulnar O
Flexor head
digitorum O
superficialis O
Radial head
Flexor digitorum
profundus
Flexor pollicis
longus
I
I
I
A B C
FIGURE 7-15 A, Anterior view of the right flexor digitorum superficialis. B, Anterior view of the right
flexor digitorum profundus. C, Anterior view of the right flexor pollicis longus. The distal end of the
brachialis has been ghosted in all three figures. The pronator quadratus has been ghosted in B and
C. O, Origin; I, insertion.
WHAT'S IN A NAME? ACTIONS

The name, flexor digitorum superficialis, tells us Q The flexors digitorum superficialis and profundus
that this muscle flexes the digits (i.e., fingers) and is flex fingers two through five at the MCP and IP joints
superficial to the flexor digitorum profundus. (proximal and distal IP joints are the PIP and DIP
The name, flexor digitorum profundus, tells us that joints).
this muscle flexes the digits (i.e., fingers) and is deep Q The flexor pollicis longus flexes the thumb at the CMC
to the flexor digitorum superficialis. (saddle), MCP, and IP joints.
The name, flexor pollicis longus, tells us that this
Q Because these muscles also cross the wrist joint,
muscle flexes the thumb and is long (i.e., longer than
they can move the hand at the wrist joint.
the flexor pollicis brevis).
Derivation:
flexor: L. muscle that flexes a body part Flexor Digitorum Superficialis
digitorum: L. refers to a digit (finger) Q Flexes fingers two through five at the MCP and PIP 7
pollicis: L. thumb joints.
superficialis: L. superficial (near the surface)
Q Flexes the hand at the wrist joint.
profundus: L. deep
longus: L. long
Flexor Digitorum Profundus

Q Flexes fingers two through five at the MCP, PIP, and
DIP joints.
Q Flexes the hand at the wrist joint.
ATTACHMENTS
Flexor Digitorum Superficialis Flexor Pollicis Longus
Origin (Proximal Attachment) Q Flexes the thumb at the CMC, MCP, and IP joints.
Q Medial epicondyle of the humerus via the common Q Flexes the hand at the wrist joint.
flexor tendon, and the anterior ulna and radius
STABILIZATION
Q Anterior surfaces of fingers two through five As a group, these muscles stabilize the CMC, MCP and
IP joints of the fingers and thumb, as well as the wrist
joint.
Flexor Digitorum Profundus
Q Medial and anterior ulna
INNERVATION
Q Median and ulnar nerves
Q Anterior surfaces of fingers two through five Note: The median nerve innervates all three muscles in this
group. The ulnar nerve also innervates the flexor digitorum
profundus.
Q Anterior surface of the radius, and the ulna and
medial epicondyle of the humerus

Q Thumb
Turn page to 'more.

PALPATION
Flexor Digitorum Superficialis
and Flexor Digitorum Profundus
1. The client is seated with the arm relaxed; the forearm
is flexed at the elbow joint and fully supinated and
resting on the client’s thigh.
2. For the flexor digitorum superficialis, place your pal-
pating finger pads on the proximal medial forearm,
slightly distal and anterior to the medial epicondyle of
the humerus. Ask the client to flex the proximal pha-
langes of fingers two through five at the MCP joints.
7 Note: If resistance is given, be sure to isolate your pressure A

against the proximal phalanges of the fingers (Figure 7-16, A).
3. Feel for the contraction of the flexor digitorum

superficialis. Palpate the flexor digitorum superficialis
by strumming perpendicular to the fibers from the
proximal attachment at the medial epicondyle to the
distal tendons at the anterior wrist.
4. For the flexor digitorum profundus, place your
palpating finger pads on the proximal medial forearm,
slightly distal and posterior to the medial epicondyle
and against the shaft of the ulna. Ask the client
to flex the middle and distal phalanges of fingers
two through five at the proximal and distal IP joints B
and feel for the contraction of the flexor digitorum
profundus (Figure 7-16, B).
5. Palpate the flexor digitorum profundus as far distally
as possible by strumming perpendicular to the fibers.

1. The client is seated with the arm relaxed, and the fore-
arm is flexed at the elbow joint and fully supinated and
resting on the client’s thigh. Place your palpating finger
pads just proximal to the wrist joint on the radial side.
2. Ask the client to flex the distal phalanx of the thumb C
at the IP joint. With gentle pressure, feel for the
contraction of the flexor pollicis longus near the wrist FIGURE 7-16 Palpation of the flexors digitorum and pollicis
(Figure 7-16, C). group. A, Palpation of the right flexor digitorum superficialis,
starting distal and anterior to the medial epicondyle of the
3. Continue palpating the flexor pollicis longus as far humerus. B, Palpation of the right flexor digitorum profundus,
proximal as possible as the client alternately contracts starting against the shaft of the ulna. Note the difference in
and relaxes it by flexing the thumb at the IP joint. the type of finger flexion that is performed by the client against
resistance. C, Palpation of the belly of the right flexor pollicis
Note: Because this muscle is so deep, trying to strum longus as the thumb flexes at the interphalangeal (IP) joint. The
perpendicular to its fibers is usually not helpful. pronator quadratus has been ghosted in.
Q The median nerve and Q Overuse and irritation of the flexor pollicis longus is
the distal tendons of all becoming more common
three muscles in this as a result of the use of
group travel within cell phones. This muscle
synovial sheaths within is also often overused and
the carpal tunnel. Overuse injured in manual/massage
and irritation of these therapists.
muscles can cause swelling,
Q The proximal attachments
which can press on the
of the flexor pollicis
median nerve, causing
longus are variable. The
carpal tunnel syndrome.
humeral and/or ulnar
Q The flexor digitorum attachments are often
superficialis attaches to the common flexor tendon at the missing.
medial epicondyle of the humerus. Irritation or inflammation
Q The radial artery is near the flexor pollicis longus, so if 7
of the medial epicondyle and/or the common flexor tendon
you feel a pulse, move off the artery.
is known as medial epicondylitis, medial epicondylosis, or
golfer’s elbow.
FOREARM AND HAND: Wrist Extensor Group

Extensor Carpi Radialis Longus; Extensor Carpi Radialis Brevis;
Extensor Carpi Ulnaris
Pronunciation EKS 4%. SOR+!2 PIE2!9 DEE ! LIS,/.' US s
EKS 4%. SOR+!2 PIE2!9 DEE ! LIS"2% VIS s EKS 4%. SOR+!2 PIEUL .! RIS
The wrist extensor group is

composed of three muscles that
all originate (have their proximal
attachment) either at the lateral
7 epicondyle of the humerus via
the common extensor tendon O
Lateral epicondyle
or nearby. They all cross the of humerus
wrist joint posteriorly; therefore
they can all extend the hand at
Extensor carpi
the wrist joint, hence the name radialis longus
of the group. These muscles
are the extensor carpi radialis
longus, extensor carpi radialis Extensor carpi
radialis brevis
brevis, and extensor carpi ulnaris.
All three muscles of the wrist
extensor group are superficial
in the posterior forearm. At the Extensor
carpi ulnaris
wrist joint, both extensor carpi
radialis muscles cross on the
radial side, and the extensor carpi
ulnaris crosses on the ulnar side
(Figure 7-17). In addition to the
humeral attachment, the extensor
carpi ulnaris also has an ulnar
attachment.
FIGURE 7-17 Posterior view of

the right wrist extensor group of
muscles. O, Origin; I, insertion.
WHAT'S IN A NAME? ACTIONS

The names, extensor carpi radialis longus and The muscles of the wrist extensor group move the
extensor carpi radialis brevis, tell us that these hand at the wrist joint.
muscles extend and radially deviate (abduct). Carpi
tells us that these actions occur at the wrist joint.
Longus designates the muscle as being longer than
Extensor Carpi Radialis Longus
the brevis. and Extensor Carpi Radialis Brevis
The name, extensor carpi ulnaris, tells us that this Q Extend the hand at the wrist joint.
muscle extends and ulnar deviates (adducts) the wrist Q Radially deviate the hand at the wrist joint.
joint.
Derivation:
extensor: L. muscle that extends a body part Extensor Carpi Ulnaris
carpi: L. of the wrist Q Extends the hand at the wrist joint.
7
radialis: L. refers to the radial side (of the forearm) Q Ulnar deviates the hand at the wrist joint.
ulnaris: L. refers to the ulnar side (of the forearm)
longus: L. longer
brevis: L. shorter STABILIZATION
Stabilizes the wrist and elbow joints.
ATTACHMENTS INNERVATION
Q Radial nerve
Extensor Carpi Radialis Longus
Q Lateral supracondylar ridge of the humerus PALPATION
Insertion (Distal Attachment) Extensor Carpi Radialis Longus
Q Posterior hand on the radial side and Extensor Carpi Radialis Brevis
forearm flexed at the elbow joint and in a position that
Extensor Carpi Radialis Brevis is halfway between full pronation and full supination;
Origin (Proximal Attachment) the forearm is resting on the client’s thigh.
Q Lateral epicondyle of the humerus via the common 2. The radial group is pinched with the palpating fingers
extensor tendon and separated from the rest of the musculature of the
forearm. Pinch the radial group of muscles between
Insertion (Distal Attachment) your thumb on one side and your index finger (or
index and middle fingers) on the other side; gently pull
Q Posterior hand on the radial side
them away from the forearm (Figure 7-18, A).
3. Move your palpating finger pads onto the extensors
Extensor Carpi Ulnaris carpi radialis longus and brevis (posterior to the
brachioradialis) and feel for their contraction as the
Origin (Proximal Attachment) client radially deviates the hand at the wrist joint
Q Lateral epicondyle of the humerus via the common (Figure 7-18, B). Resistance to radial deviation can be
extensor tendon, and the ulna added with your support/resistance hand, if desired.
4. Continue palpating the extensor carpi radialis muscles
Insertion (Distal Attachment) toward their distal attachments by strumming
Q Posterior hand on the ulnar side perpendicularly across them.
Turn page to 'more.

Extensor Carpi Ulnaris

is flexed at the elbow joint, fully pronated at the
radioulnar joints, and resting on the client’s thigh.
2. Place your palpating finger pads immediately

posterior to the shaft of the ulna.
3. Ask the client to ulnar deviate the hand at the wrist

joint and feel for the contraction of the extensor carpi
ulnaris (Figure 7-19). If resistance is given, place your
resistance hand on the ulnar side of the client’s hand,
proximal to the fingers.
4. Palpate proximally toward the lateral epicondyle and

7 distally toward the fifth metacarpal by strumming
perpendicular to the fibers as the client alternately
contracts and relaxes the muscle.
FIGURE 7-19 Palpation of the right extensor carpi ulnaris

immediately posterior to the shaft of the ulna as the client ulnar
A
deviates the hand at the wrist joint against resistance.
FIGURE 7-18 A, Right radial group of muscles is being pinched

between the thumb and index finger of the therapist. B, Pal-
pation of the extensors carpi radialis longus and brevis as the
client radially deviates the hand at the wrist joint.
Q Overuse of the wrist Q Stabilizing the wrist joint is an important action of the wrist
extensor group can extensor group, especially the extensor carpi radialis brevis.
cause irritation and/or When the finger flexors contract to make a fist, wrist joint
inflammation of the extensor muscles contract to prevent these finger flexor
lateral epicondyle and/or muscles from also flexing the hand at the wrist joint.
the common extensor
Q The attachment of the extensor carpi ulnaris onto the ulna
tendon. This condition
blends with the ulnar attachment of the flexor carpi ulnaris
is known as lateral
and the flexor digitorum profundus.
epicondylitis, lateral
epicondylosis, or
tennis elbow.
7
FOREARM AND HAND

Extensor Digitorum; Extensor Digiti Minimi
Pronunciation EKS 4%. SORDIJ I 4/% RUM s EKS 4%. SOR$)* I TEE-). I MEE
The extensor digitorum and extensor digiti minimi are superfi-

cial muscles in the posterior forearm and are located between the
muscles of the wrist extensor group. They are considered to be
long extrinsic finger muscles because they originate (have their
proximal attachment) outside of the hand. They extend fingers
two through five (Figure 7-20).
7
O O
Extensor digitorum (ED) Extensor digiti minimi
Tendon of the ED
to the little finger
I
I
A B
FIGURE 7-20 A, Posterior view of the right extensor digitorum. The extensor digiti minimi has been
ghosted in. B, Posterior view of the right extensor digiti minimi. The extensor digitorum has been
WHAT'S IN A NAME?
The name, extensor digitorum, tells us that this muscle Derivation:
extends the digits (i.e., fingers). extensor: L. muscle that extends a body part
The name, extensor digiti minimi, tells us that this digitorum: L. refers to a digit (finger)
muscle extends the little finger. digiti: L. refers to a digit (finger)
minimi: L. least
ATTACHMENTS
Extensor Digitorum
Q Lateral epicondyle of the humerus via the common
extensor tendon

Q Posterior surfaces of fingers two through five
Extensor Digiti Minimi

Q Lateral epicondyle of the humerus via the common 7
extensor tendon FIGURE 7-21 Palpation of the right extensor digitorum and
extensor digiti minimi as the client extends fingers two through
five against resistance.
Q Little finger (finger five)
2. Ask the client to extend fingers two through five fully
at the MCP and IP joints (be sure that the client is not
ACTIONS attempting to also extend the hand at the wrist joint),
The extensor digitorum and extensor digiti minimi and feel for the contraction of the extensor digitorum
move the fingers at MCP joints and at the PIP and DIP and extensor digiti minimi (Figure 7-21).
joints; they also move the hand at the wrist joint.
Note: Discerning the border of these two muscles is difficult.
Extensor Digitorum 3. If resistance is given, place your resistance hand
Q Extends fingers two through five at the MCP, PIP, and on the posterior side of the fingers, not over the
DIP joints. metacarpals of the hand.
Q Extends the hand at the wrist joint. 4. Continue palpating toward the insertion and then the
origin (distal and proximal attachments) by strumming
perpendicular to the fibers of these two muscles.
Extensor Digiti Minimi
Q Extends the little finger (finger five) at the MCP, PIP, Note: The distal tendons of the finger extensors can often
and DIP joints. be seen on the posterior surface of the hand.
Q Extends the hand at the wrist joint.
STABILIZATION TREATMENT CONSIDERATIONS

1. Stabilizes the MCP, PIP, and DIP joints. Q The distal attachment of the extensor digitorum spreads out
2. Stabilizes the wrist joint. to become a fibrous expansion that covers the posterior,
3. Stabilizes the fifth CMC joint. medial, and lateral sides of the proximal phalanx. It then
continues distally to attach onto the posterior sides of the
middle and distal phalanges.
This structure is called the
INNERVATION dorsal digital expansion.
Q Radial nerve Q Irritation and/or inflammation
of the lateral epicondyle
and/or the common
PALPATION extensor tendon is
known as lateral
1. The client is seated with the arm relaxed; the forearm epicondylitis, lateral
is flexed at the elbow joint, fully pronated at the epicondylosis, or
radioulnar joints, and resting on the client’s thigh. tennis elbow.
Place your palpating finger pads on the middle of the Q The belly of the extensor digiti minimi often blends with the
posterior proximal forearm. belly of the extensor digitorum.
FOREARM AND HAND

Supinator
Pronunciation 35% PIN !9 TOR
The supinator is located WHAT'S IN A NAME?

proximally in the deep The name, supinator, tells us that this muscle
compartment of the posterior supinates the forearm.
forearm (Figure 7-22). Derivation:
supinator: L. muscle that supinates a body part
7
ATTACHMENTS
O Q Lateral epicondyle of the humerus and the proximal
ulna

Q Proximal radius
I
ACTIONS
Q Supinates the forearm at the radioulnar joints.
STABILIZATION
Stabilizes the radioulnar and elbow joints.
INNERVATION
Q Radial nerve
PALPATION
1. The client is seated with the arm relaxed, and the
forearm is flexed at the elbow joint in a position that is
halfway between full pronation and full supination and
is resting on the client’s thigh. Place your resistance
hand on the client’s distal forearm, just proximal to the
wrist joint.
2. With your palpating hand, pinch the radial group
of muscles between your thumb on one side and
your index and middle fingers on the other side, and
gently pull them away from the forearm (see Figure
7-18, A). Now gently but firmly sink in (between the
extensor carpi radialis brevis of the radial group and
FIGURE 7-22 Posterior view of the right supinator. The anconeus, the extensor digitorum) with your thumb (if palpating
extensor carpi radialis longus (cut), and extensor carpi radialis with your right hand) toward the supinator attachment
brevis (cut) have been ghosted in. O, Origin; I, insertion.
on the radius.
Q Proximally, the supinator muscle
has a superficial layer and a
deep layer. A deep branch
of the radial nerve runs
between the two layers
and may be entrapped
there.
Q Irritation and/or
inflammation of the
lateral epicondyle and/or
the common extensor
tendon is known as lateral epicondylitis, lateral epicondylosis,
or tennis elbow.
FIGURE 7-23 Palpation of the right supinator against the radius Q The deep branch of the radial nerve runs through the 7
between the radial group of muscles and the extensor digitorum. supinator muscle. Be aware of this when pressing in
deeply against the supinator.
3. Ask the client to supinate the forearm against resis-
tance, and feel for the contraction of the supinator
(Figure 7-23).
4. Continue palpating the supinator (through the
more superficial musculature) toward its proximal
attachment, and feel for its contraction as the client
alternately contracts and relaxes the supinator.
FOREARM AND HAND: Deep Distal Four Group

Abductor Pollicis Longus; Extensor Pollicis Brevis;
Extensor Pollicis Longus; Extensor Indicis
Pronunciation AB $5+ TOR0/, I SIS,/.' US s EKS 4%. SOR0/, I SIS"2% VIS s
EKS 4%. SOR0/, I SIS,/.' US s EKS 4%. SOR). DI SIS
The deep distal four group is a group of four muscles

located distally in the deep compartment of the posterior
forearm. Three of these muscles move the thumb; the
fourth muscle moves the index finger (Figure 7-24).
7
Abductor
O pollicis longus
Extensor
pollicis brevis Extensor indicis
Extensor indicis
A B
FIGURE 7-24 Posterior views of the muscles of the right deep distal four group. A, All four muscles
are shown with the supinator ghosted in. B, The abductor pollicis longus and extensor pollicis
longus have now been ghosted in. O, Origin; I, insertion.
WHAT'S IN A NAME? Extensor Indicis

The name, abductor pollicis longus, tells us that this Origin (Proximal Attachment)
muscle abducts the thumb and is long (longer than Q Posterior ulna
the abductor pollicis brevis).
The name, extensor pollicis brevis, tells us that this Insertion (Distal Attachment)
muscle extends the thumb and is shorter than the
Q Index finger (finger two)
extensor pollicis longus.
The name, extensor pollicis longus, tells us that
this muscle extends the thumb and is longer than the
extensor pollicis brevis. ACTIONS
The name, extensor indicis, tells us that this
muscle extends the index finger. The muscles of the deep distal four group move the
thumb at the CMC (saddle), MCP, and IP joints, and
Derivation: the index finger at the MCP and proximal and distal IP 7
abductor: L. muscle that abducts a body part (PIP and DIP) joints.
extensor: L. muscle that extends a body part
pollicis: L. thumb Note: Abduction of the thumb is a sagittal plane motion in
indicis: L. index finger (finger two) which the thumb is brought anteriorly away from the plane
longus: L. longer of the palm of the hand. Extension of the thumb is a frontal
brevis: L. shorter plane motion in which the thumb is moved away from the
index finger.
Abductor Pollicis Longus

ATTACHMENTS Q Abducts the thumb at the CMC joint.
Q Extends the thumb at the CMC joint.
Abductor Pollicis Longus
Origin (Proximal Attachment) Extensor Pollicis Brevis
Q Posterior radius and ulna Q Extends the thumb at the CMC and MCP joints.
Q Abducts the thumb at the CMC joint.
Q Thumb
Extensor Pollicis Longus
Q Extends the thumb at the CMC, MCP, and IP joints.
Extensor Pollicis Brevis
Origin (Proximal Attachment) Extensor Indicis
Q Posterior radius Q Extends the index finger at the MCP, PIP, and DIP
joints.
Q Thumb STABILIZATION
1. Stabilizes the CMC (saddle), MCP, and IP joints of the
thumb.
Extensor Pollicis Longus 2. Stabilizes the MCP, PIP, and DIP joints of the index
Origin (Proximal Attachment) finger.
Q Posterior ulna

INNERVATION
Q Thumb Q Radial nerve
Turn page to 'more.

PALPATION
is flexed at the elbow joint, fully pronated at the
radioulnar joints, and resting on the client’s thigh.
2. Ask the client to actively extend the thumb (in the
frontal plane) and look to see the distal tendons of
this group that border the anatomic snuffbox.
3. Now begin palpating the distal tendons on the radial
side of the posterior wrist.
Note: The tendons of the abductor pollicis longus and
extensor pollicis brevis are right next to one another and
may appear to be one tendon; you can gently separate
7 them with a fingernail. A
4. Once located, palpate each of these muscles

individually back to its proximal attachment by
strumming perpendicular to the fibers as the client
alternately contracts and relaxes each muscle by
extending the thumb (Figure 7-25, A).
5. To palpate the extensor indicis, first locate its distal
tendon on the posterior side of the hand by asking
the client to extend the index finger at the MCP and
IP joints (Figure 7-25, B).
6. Continue palpating the extensor indicis proximally
by strumming perpendicular to its fibers as the client
alternately contracts and relaxes the muscle.
B
FIGURE 7-25 A, Palpation of the three thumb muscles of the
right deep distal four group (abductor pollicis longus, and
extensors pollicis brevis and longus) as the client fully extends
the thumb. B, Palpation of the right extensor indicis of the deep
distal four group as the client fully extends the index finger.
Q The distal tendons of the three Q The abductor pollicis longus and the extensor
thumb muscles of the deep distal pollicis brevis share a common synovial sheath.
four group border the anatomic With excessive movements of the thumb, the
snuffbox. The abductor pollicis friction between the tendons of the abductor
longus and extensor pollicis brevis pollicis longus and/or the extensor pollicis
create the lateral border (they are brevis and the styloid process of the radius
very close together and can be can cause atenosynovitis (inflammation of the
difficult to distinguish from each synovial sheath). This condition is known as de
other); the extensor pollicis longus Quervain's disease.
creates the medial border. The Q The distal attachment of the extensor pollicis
scaphoid bone is located within the longus spreads out to become the fibrous
anatomic snuffbox. dorsal digital expansion of the thumb.
Notes
FOREARM AND HAND: Thenar Eminence Group

Abductor Pollicis Brevis; Flexor Pollicis Brevis; Opponens Pollicis
Pronunciation AB $5+ TOR0/, I SIS"2% VIS s
&,%+3 OR0/, I SIS"2% VIS s OP 0/ NENS0/, I SIS
The thenar eminence group is composed of three muscles: (1) abductor

pollicis brevis, (2) flexor pollicis brevis, and (3) opponens pollicis. These
muscles are intrinsic hand muscles (wholly located within the hand)
that attach onto and move the thumb. The abductor is the most superfi-
cial, the flexor is intermediate in depth, and the opponens is the deepest
(Figure 7-26).
7
Opponens pollicis (OP) Transverse carpal ligament

O
APB (cut)
Abductor OP
I pollicis
brevis (APB) FPB (cut)
Flexor
pollicis brevis
(FPB) APB (cut)
A B
FIGURE 7-26 Anterior views of the right thenar group muscles. A, Superficial view. B, Deep view.
The abductor pollicis brevis and flexor pollicis brevis have been cut. O, Origin; I, insertion.
WHAT'S IN A NAME? Note: Abduction of the thumb is a sagittal plane motion

in which the thumb is brought anteriorly away from the
The name, abductor pollicis brevis, tells us that this plane of the palm of the hand. Flexion of the thumb is a
muscle abducts the thumb and is short (shorter than frontal plane motion in which the thumb is brought toward
the abductor pollicis longus). the index finger. Opposition of the thumb occurs when the
The name, flexor pollicis brevis, tells us that this thumb pad meets the pad of another finger.
muscle flexes the thumb and is short (shorter than the
flexor pollicis longus).
The name, opponens pollicis, tells us that this Abductor Pollicis Brevis
muscle opposes the thumb. Q Abducts the thumb at the CMC joint.
Derivation:
abductor: L. muscle that abducts a body part Flexor Pollicis Brevis
flexor: L. muscle that flexes a body part Q Flexes the thumb at the CMC and MCP joints.
opponens: L. opposing
pollicis L. thumb
7
brevis: L. shorter Opponens Pollicis
Q Opposes the thumb at the CMC joint.
STABILIZATION
The thenar group stabilizes the CMC and MCP joints of
ATTACHMENTS the thumb.
Abductor Pollicis Brevis

Origin (Proximal Attachment) INNERVATION
Q Flexor retinaculum and the scaphoid and trapezium Q Median nerve
Q Ulnar nerve
Note: The median nerve innervates all three thenar
Q Proximal phalanx of the thumb
muscles; the ulnar nerve also innervates the flexor pollicis
brevis and opponens pollicis.
Flexor Pollicis Brevis
Origin (Proximal Attachment) PALPATION
Q Flexor retinaculum and trapezium
1. The client is seated. Place your palpating finger
Insertion (Distal Attachment) pads on the lateral side of the thenar eminence of
the client; place your resistance hand on the
anterior surface of the proximal phalanx of the
client’s thumb.
Opponens Pollicis 2. For the abductor pollicis brevis, palpate the
lateral side of the thenar eminence and feel for its
Origin (Proximal Attachment) contraction as you gently to moderately resist the
Q Flexor retinaculum and trapezium client from abducting the thumb at the saddle joint.
3. Pinching the muscle between your thumb and index
Insertion (Distal Attachment) finger can be helpful (Figure 7-27, A).
Q First metacarpal (of the thumb)
4. Once felt, palpate the muscle to its proximal and
distal attachments.
ACTIONS 5. For the flexor pollicis brevis, palpate the most medial
aspect of the thenar eminence and feel for its
The thenar muscles move the thumb at the CMC contraction as you moderately resist the client from
(saddle) and MCP joints. flexing the thumb at the saddle joint (Figure 7-27, B).
Turn page to 'more.

6. Once felt, try to palpate it deep to the abductor pollicis

brevis more laterally as the client alternately contracts
the muscle against gentle resistance and relaxes it.
7. For the opponens pollicis, curl your palpating
finger(s) around the shaft of the metacarpal of the
thumb (Figure 7-27, C). Ask the client to oppose
the thumb against the little finger, exerting gentle
pressure against the pad of the little finger; feel for the
contraction of the opponens pollicis.
8. Once felt against the metacarpal, attempt to palpate
the rest of this muscle deep to the other thenar
A muscles.
7 Note: Discerning the opponens pollicis from the other the-

nar muscles can be very difficult. For this reason, palpating
for tight spots in this muscle is usually more effective with
the thenar musculature relaxed.
Q With the tremendous increase of cell phone texting, the
thumb muscles are being overused, which can lead to a
repetitive-use syndrome that is called texting thumb. Manual
therapists need to be especially aware of this condition,
B given that they already tend
to use their thumbs so
much when performing
soft tissue manipulation.
Q The overuse of our thumbs
for texting will likely also
increase the incidence
of arthritic changes
(degenerative joint
disease) of the saddle
joint of the thumb. This
condition is known as
basilar arthritis.
Q A sesamoid bone is
C located in the distal
tendon of the flexor
pollicis brevis. Note: A
FIGURE 7-27 Palpation of the right thenar group. A, Palpation of second sesamoid bone
the abductor pollicis brevis as the client abducts the thumb at of the thumb is located
the carpometacarpal (CMC) joint against resistance. B, Palpation in the distal tendon of the
of the flexor pollicis brevis as the client flexes the thumb at the adductor pollicis.
CMC joint against resistance. C, Palpation of the opponens pol- Q Apes can oppose their
licis by curling around the metacarpal of the thumb as the client thumb, but it is so
opposes the thumb at the CMC joint to the little finger. short that it is not very
functional for grasping
objects.
Notes
FOREARM AND HAND: Hypothenar Eminence Group

Abductor Digiti Minimi Manus; Flexor Digiti Minimi Manus;
Opponens Digiti Minimi
Pronunciation AB $5+ TOR$)* I TEE-). I MEE-!. US s
&,%+3 OR$)* I TEE-). I MEE-!. US s OP 0/ NENS$)* I TEE-). I MEE
The hypothenar eminence group is composed of three

muscles: (1) abductor digiti minimi manus, (2) flexor digiti
minimi manus, and (3) opponens digiti minimi. Note the
similarity to the thenar group—both groups have an abductor,
7 flexor, and opponens. Hypothenar muscles are intrinsic hand
muscles (wholly located within the hand) that attach onto
and move the little finger. The abductor is the most superficial,
the flexor is intermediate in depth, and the opponens is the
deepest (Figure 7-28).
Flexor carpi ulnaris ADMM (cut)
Transverse carpal
ligament (flexor
FDMM (cut)
retinaculum)
O
Abductor digiti minimi

manus (ADMM)
Opponens
Flexor digiti minimi
digiti minimi
manus (FDMM)
FDMM (cut)
A B
FIGURE 7-28 Anterior views of the right hypothenar group muscles. A, Superficial view. The flexor
carpi ulnaris has been drawn in. B, Deep view. The abductor digiti minimi manus (ADMM) and
flexor digiti minimi manus (FDMM) have been cut. O, Origin; I, insertion.
WHAT'S IN A NAME? Flexor Digiti Minimi Manus

The name, abductor digiti minimi manus, tells us that
Q Flexes the little finger at the MCP joint.
this muscle abducts the little finger.
The name, flexor digiti minimi manus, tells us that Opponens Digiti Minimi
this muscle flexes the little finger. Q Opposes the little finger at the CMC joint.
The name, opponens digiti minimi, tells us that this
muscle opposes the little finger. STABILIZATION
Derivation:
abductor: L. muscle that abducts a body part Stabilizes the CMC and MCP joints of the little finger.
flexor: L. muscle that flexes a body part
opponens: L. opposing
digiti: L. refers to a digit (finger) INNERVATION
minimi: L. least Q Ulnar nerve
manus: L. refers to the hand 7
PALPATION
1. The client is seated. Place your palpating finger pads
ATTACHMENTS on the medial side of the hypothenar eminence of
the client. Place your resistance finger on the medial
Abductor Digiti Minimi Manus surface of the proximal phalanx of the client’s little finger.
2. For the abductor digiti minimi manus, feel for its
Origin (Proximal Attachment) contraction at the medial side of the hypothenar
Q Pisiform eminence as you resist the client from abducting the
little finger at the MCP joint (Figure 7-29, A).
Insertion (Distal Attachment) 3. Once felt, palpate distally to the medial side of the
Q Proximal phalanx of the little finger (finger five) base of the proximal phalanx and proximally to the
pisiform.
Flexor Digiti Minimi Manus 4. For the flexor digiti minimi manus, feel for its
contraction on the lateral side of the hypothenar
Origin (Proximal Attachment) eminence as you resist the client from flexing the little
Q Flexor retinaculum and the hamate finger at the MCP joint, while keeping the little finger
extended at the IP joints (Figure 7-29, B).
Insertion (Distal Attachment) Note: Your resistance finger should be placed over the ante-
Q Proximal phalanx of the little finger (finger five) rior surface of the proximal phalanx of the little finger.
5. Once felt, palpate distally to the anteromedial surface

Opponens Digiti Minimi of the base of the proximal phalanx and proximally to
the hook of the hamate.
6. For the opponens digiti minimi, feel for its contraction
Q Flexor retinaculum and the hamate immediately distal to the hook of the hamate at the
most lateral aspect of the hypothenar eminence as
Insertion (Distal Attachment) the client opposes the little finger against the thumb
Q Fifth metacarpal (of the little finger) (Figure 7-29, C).
7. Once felt, palpate distally as far as possible deep to
the other muscles of the hypothenar eminence.
ACTIONS 8. Curling your palpating finger around to the anterior
side of the shaft of the fifth metacarpal can usually
The hypothenar muscles move the little finger at the palpate the metacarpal attachment of the opponens
CMC and MCP joints. digiti minimi (Figure 7-29, D).
Abductor Digiti Minimi Manus Note: This palpation step is similar to how the opponens
pollicis is palpated against the first metacarpal.
Q Abducts the little finger at the MCP joint.
Turn page to 'more.

A B
C D
FIGURE 7-29 Palpation of the right hypothenar group. A, Palpation of the abductor digiti
minimi manus at the medial side of the hypothenar eminence as the client abducts the little
finger against resistance. B, Palpation of the flexor digiti minimi manus at the lateral side of
the hypothenar eminence as the client flexes the proximal phalanx of the little finger against
resistance. C, Palpation of the opponens digiti minimi at the far lateral side of the hypothenar
eminence as the client opposes the little finger against resistance. D, Palpation of the opponens
digiti minimi against the metacarpal of the little finger as the client opposes the little finger
against resistance.
Q The origin (proximal attachment) of the abductor digiti minimi Q The flexor digiti minimi manus is often very
manus is the pisiform. Whenever the abductor digiti minimi small or entirely absent. When this occurs,
contracts, the flexor carpi ulnaris also contracts to fix (stabilize) the opponens digiti minimi will have
the pisiform. This knowledge can be used to engage and relatively more superficial exposure.
palpate the flexor carpi ulnaris. Ask for the client to abduct the
Q We do not normally
little finger actively; the distal tendon of the flexor carpi ulnaris
think of the little
at the distal wrist on the ulnar side can be felt to contract.
finger as having to
work very hard;
however, manual therapy
can physically stress
the hypothenar muscles
of the little finger,
especially if pinching
(opposition) motions are
performed often.
Notes
FOREARM AND HAND

Palmaris Brevis
Pronunciation PALL -! RIS"2% VIS
The palmaris brevis is

technically not part of the
hypothenar group because
it does not attach onto
and move the little finger.
It is a very thin superficial
muscle located within Palmaris longus
7
the fascia and dermis that
overlie the hypothenar
Palmaris brevis
eminence. For this reason,
it is being considered here O I
(Figure 7-30).
Palmar aponeurosis
FIGURE 7-30 Anterior view of the right palmaris brevis. O, Origin; I, insertion.
WHAT'S IN A NAME? ATTACHMENTS

The name, palmaris brevis, tells us that this muscle Origin (Proximal Attachment)
attaches into the palm of the hand and is short
Q Flexor retinaculum and the palmar aponeurosis
(shorter than the palmaris longus).
Derivation:
palmaris: L. refers to the palm
Q Dermis of the ulnar (medial) border of the hand
brevis: L. shorter
ACTIONS
Q Wrinkles the skin of the palm.
STABILIZATION
The palmaris brevis has no joint stabilization function.
INNERVATION
Q Ulnar nerve
7
PALPATION
1. The client is seated. Gently place your palpating finger
pad(s) over the hypothenar eminence.
2. Ask the client to cup the palm of the hand; feel for FIGURE 7-31 Palpation of the right palmaris brevis.
this muscle’s contraction (Figure 7-31). Be sure that
the little finger is either not moved at all or moved as
little as possible, or you will feel the contraction of the
hypothenar muscles.
Note: The palmaris brevis is extremely thin and difficult to

discern from adjacent soft tissue.
FOREARM AND HAND: Central Compartment Group

Adductor Pollicis; Lumbricals Manus; Palmar Interossei;
Dorsal Interossei Manus
Pronunciation AD $5+ TOR0/, I SIS s ,5- BRI KULS-!. US s
0!, MAR). TER /33 EE I s $/2 SUL). TER /33 EE I-!. US
The central compart- Flexor digitorum profundus

ment is composed of
intrinsic hand mus-
cles that are located Oblique head
7 between the thenar and
hypothenar eminences. Lumbricals manus
The central compart- I O O
ment includes the
adductor pollicis, four
muscles of the lumbri- I
cals manus group, three
Transverse
muscles of the palmar head
interossei group, and
four muscles of the
dorsal interossei manus
A B
group (Figure 7-32).
All of these muscles are
found and palpated in
the palm of the hand
except for the dor- Dorsal
interossei
sal interossei manus manus
group, which is located Palmar
interossei
on the dorsal side (the
adductor pollicis is in O
the thumb web and O
can be palpated from
both sides). The lum-
I
bricals manus, palmar
I
interossei, and dorsal
interossei manus are
named by numbering
them, beginning on the
thumb (radial) side.
C D
FIGURE 7-32 A, Anterior view of the right adductor pollicis. B, Anterior view of the right lumbricals
manus. The flexor digitorum profundus muscle has been drawn in. C, Anterior view of the right
palmar interossei. D, Posterior view of the right dorsal interossei manus. B, C, and D have the
adductor pollicis ghosted in. O, Origin; I, insertion.
WHAT'S IN A NAME? Dorsal Interossei Manus

The name, adductor pollicis, tells us that this muscle Origin (Proximal Attachment)
adducts the thumb. Q Metacarpals of fingers one through five
The name, lumbricals manus, tells us that these
muscles are shaped like earthworms and are located Insertion (Distal Attachment)
in the hand. Q Proximal phalanges of fingers two, three, and four on
The name, palmar interossei, tells us that these
the side that faces away from the center of the middle
muscles are located between bones (metacarpals) on
finger
the palmar (anterior) side.
The name, dorsal interossei manus, tells us
that these muscles are located between bones
(metacarpals) on the dorsal (posterior) side and ACTIONS
located in the hand.
The central compartment muscles move the thumb at 7
Derivation: the CMC (saddle) joint, and move fingers two through
adductor: L. muscle that adducts a body part five at the MCP joints.
pollicis: L. thumb
manus: L. refers to the hand Note: Abduction of fingers two through five is a motion dur-
palmar: L. refers to the palm ing which the fingers move away from an imaginary line
dorsal: L. back drawn through the middle finger when it is in anatomic
interossei: L. between bones position. The middle finger itself can abduct in both the
lumbricals: L. earthworms radial and ulnar direction. Adduction of fingers two through
five is a motion during which the fingers move toward the
same imaginary reference line; the middle finger itself, by
definition, cannot adduct.
ATTACHMENTS
Adduction of the thumb is a sagittal plane motion
Adductor Pollicis during which the thumb is brought posteriorly back
toward the plane of the palm of the hand.
Q Third metacarpal and capitate
Adductor Pollicis
Insertion (Distal Attachment) Q Adducts the thumb at the CMC joint.
Lumbricals Manus
Lumbricals Manus Q Flexes fingers two through five at the MCP joints.

Q Distal tendons of the flexor digitorum profundus Palmar Interossei
muscle Q Adducts fingers two, four, and five at the MCP joints.

Q Distal tendons of the extensor digitorum muscle (the Dorsal Interossei Manus
dorsal digital expansion) Q Abducts fingers two through four at the MCP joints.
Palmar Interossei STABILIZATION

Origin (Proximal Attachment) 1. The adductor pollicis stabilizes the thumb at the CMC
Q Metacarpals of fingers two, four, and five and MCP joints of the thumb.
2. The other central compartment muscles stabilize the
Insertion (Distal Attachment) MCP joints of fingers two through five.
Q Proximal phalanges of fingers two, four, and five on 3. The first dorsal interosseus also stabilizes the CMC
the “middle finger side” joint of the thumb.
Turn page to 'more.

INNERVATION 2. To palpate the first lumbrical manus: Palpate over

the anterolateral surface of the shaft of the second
Q Ulnar nerve metacarpal, ask the client to flex the index finger at
Q Median nerve the MCP joint while keeping the IP joints completely
extended, and feel for the contraction of the first
The ulnar nerve innervates all central compartment
lumbrical manus muscle (Figure 7-34, A). Once
muscles. The median nerve also innervates the lum-
located, palpate from attachment to attachment.
bricals manus group. The median nerve innervates the
first and second lumbricals; the ulnar nerve innervates 3. To palpate the second lumbrical manus: Follow the
the third and fourth lumbricals. same procedure as used for the first lumbrical manus
muscle. Palpate over the anterolateral surface of the
third metacarpal, and feel for its contraction as the
PALPATION client flexes the third finger at the MCP joint with the
IP joints fully extended (Figure 7-34, B). Once located,
Adductor Pollicis palpate from attachment to attachment.
7
1. The client is seated. Place your palpating finger pad(s) 4. To palpate the third and fourth lumbricals manus:
on the anterior surface of the thumb web of the Follow the same protocol. For the third lumbrical
client’s hand; place the fingers of the resistance hand manus, palpate between the third and fourth
on the posterior surface of the proximal phalanx of metacarpals. For the fourth lumbrical manus, palpate
the client’s thumb. between the fourth and fifth metacarpals.
2. While palpating the anterior side of the thumb web of
the hand, resist the client from adducting the thumb
at the saddle joint; feel for the contraction of the
adductor pollicis (Figure 7-33).
3. Once felt, palpate the entire adductor pollicis from the
proximal phalanx of the thumb to the third metacarpal
and capitate.
Lumbricals Manus
1. The client is seated. Palpating finger pad(s) are placed
over the anterolateral surface of the shaft of each
of the metacarpal bone of fingers two through five.
If resistance is given, apply it to the anterior surface A
of the proximal phalanx of the finger of the same
metacarpal bone.
FIGURE 7-34 Palpation of the right lumbricals manus in the palm

of the hand. A, Palpation of the first lumbrical manus on the lat-
eral (radial) side of the metacarpal of the index finger. B, Palpation
of the second lumbrical manus on the radial side of the metacar-
pal of the middle finger. The third and fourth lumbricals manus are
FIGURE 7-33 Palpation of the right adductor pollicis as the client palpated in a similar manner against the radial side of the meta-
adducts the thumb against resistance. carpals of the ring and little fingers, respectively.
Palmar Interossei Dorsal Interossei Manus

1. The client is seated with a pencil or highlighter placed 1. The client is seated. Palpating finger pad(s) are placed
between the index and middle fingers. Palpating on the dorsal side of the client’s hand between the
finger pad(s) are placed in the palm of the hand, metacarpal bones. The contact for resistance will
between metacarpal bones. always be on the proximal phalanx.
2. To palpate the first palmar interosseus: Palpate in 2. To palpate the fourth dorsal interosseus manus: While
the palm against the second metacarpal between palpating on the dorsal side of the hand between the
the second and third metacarpals. Ask the client to fourth and fifth metacarpals, ask the client to abduct
squeeze the highlighter between the index and middle the ring finger against your resistance; feel for the
fingers, and feel for the contraction of the first palmar contraction of the fourth dorsal interossei manus
interosseus muscle (Figure 7-35, A). (DIM) (Figure 7-36, A).
3. To palpate the second palmar interosseus: Follow 3. To palpate the third dorsal interosseus manus:
the same procedure but palpate against the fourth Following the same procedure, palpate between the
metacarpal between the fourth and third metacarpals. third and fourth metacarpals while resisting ulnar 7
Feel for the contraction of the second palmar abduction of the middle finger; feel for the contraction
interosseus as the client squeezes the highlighter of the third DIM (Figure 7-36, B).
between the ring and middle fingers (Figure 7-35, B). 4. To palpate the second dorsal interosseus manus:
4. To palpate the third palmar interosseus: Following the Following the same procedure, palpate between the
same procedure, palpate against the fifth metacarpal third and second metacarpals while resisting radial
between the fifth and fourth metacarpals. Feel for abduction of the middle finger; feel for the contraction
the contraction of the third palmar interosseus as the of the second DIM (Figure 7-36, C).
client squeezes the highlighter between the little and 5. To palpate the first dorsal interosseus manus: Palpate
ring fingers (Figure 7-35, C). in the thumb web of the hand on the dorsal side,
5. Once each palmar interosseus is located, follow especially against the second metacarpal; feel for the
it from attachment to attachment while the client contraction of the first DIM as the client abducts the
alternately contracts and relaxes the muscle. index finger (Figure 7-36, D).
6. Once each dorsal interosseus manus is located,
palpate from attachment to attachment as the client
alternately contracts and relaxes the muscle.
FIGURE 7-35 Palpation of the right palmar interossei (PI) in

the palm of the hand. A, Palpation of the first PI as the client
adducts the index finger against resistance (provided by a
highlighter). B, Palpation of the second PI as the client adducts
the ring finger against resistance. C, Palpation of the third PI as
the client adducts the little finger against resistance.
A
B C
Turn page to 'more.

A B
7
C D
FIGURE 7-36 Palpation of the right dorsal interossei manus (DIM) on the dorsal surface of the hand.
A, Palpation of the fourth DIM as the client abducts the ring finger against resistance. B, Palpation
of the third DIM as the client ulnar abducts the middle finger against resistance. C, Palpation of the
second DIM as the client radially abducts the middle finger against resistance. D, Palpation of the
first DIM as the client abducts the index finger against resistance.
Q The oblique head of the adductor pollicis has a sesamoid fatigued and tight.
bone located within it. Note: A second sesamoid bone of Ironically, an ideal way
the thumb is located in the distal tendon of the flexor pollicis to work a tight
brevis. adductor pollicis in
Q The majority of tissue of the thumb web of the hand is made the thumb web is via
up of the adductor pollicis and the first dorsal interosseus a pinching stroke!
manus. Q The first dorsal
Q
interosseus manus
The adductor pollicis contracts to create the pinching
muscle (the largest)
motion in which the thumb is brought toward the index
is sometimes known
finger in the sagittal plane (adduction at the saddle joint).
as the abductor
Therapists who use this stroke technique often in their
indicis.
practice may find that their adductor pollicis becomes
REVIEW QUESTIONS
1. What are the three muscles of the wrist flexor 6. Which of the following muscles are intrinsic
group? muscles of the hand?
a. Flexor pollicis longus and flexor pollicis brevis
________________________________________________ b. Extensor pollicis brevis and adductor pollicis
c. Abductor digiti minimi manus and palmar interossei
________________________________________________ d. Pronator teres and palmaris brevis
________________________________________________ 7. Which of the following muscles flexes and pronates

the forearm?
2. What are the three muscles of the wrist extensor a. Flexor carpi ulnaris 7
group? b. Pronator quadratus
c. Biceps brachii
________________________________________________ d. Pronator teres
________________________________________________ 8. Which of the following muscles attaches to the

medial epicondyle of the humerus via the common
________________________________________________ flexor tendon?
a. Extensor carpi radialis longus
3. What are the three muscles of the thenar group? b. Flexor carpi ulnaris
c. Abductor pollicis longus
________________________________________________ d. Dorsal interossei manus
________________________________________________ 9. Which of the following muscles attach onto the

thumb?
________________________________________________ a. Adductor pollicis and abductor pollicis brevis
b. Flexor digitorum superficialis and flexor digitorum
4. Which of the following muscles can flex and profundus
radially deviate the hand at the wrist joint? c. Opponens pollicis and opponens digiti minimi
a. Palmaris longus d. Pronator teres and pronator quadratus
b. Flexor carpi radialis
c. Flexor carpi ulnaris 10. Which of the following muscles attach onto the
d. Extensor carpi radialis longus styloid process of the radius?
a. Brachioradialis
5. Which of the following muscles can flex the thumb b. Flexor digitorum superficialis
at the IP joint? c. Pronator teres
a. Pronator teres d. Flexor carpi ulnaris
b. Flexor digitorum superficialis
c. Flexor pollicis brevis
d. Flexor pollicis longus
CASE STUDY 1
A client appears for his weekly massage appointment with 2. How would you assess this condition during the
complaints of pain in his left forearm. He is left-handed, 43 physical examination?
years of age, and in good shape. He has an active lifestyle;
he likes to do carpentry jobs around the house and plays ______________________________________________________
softball every week in a league. ______________________________________________________
Last weekend, he was working on a carpentry project
at home with a manual screwdriver for many hours. That ______________________________________________________
night, he felt soreness in his left anterior proximal forearm
that radiated toward his elbow. The pain seemed to lessen ______________________________________________________
over the next day or so. However, when he played softball ______________________________________________________
Wednesday night, the pain returned. He felt sharp pain
each time he threw the ball. As the game progressed, the ______________________________________________________
7 intensity of the pain increased until it was constant and he
______________________________________________________
could no longer play. He had to retire from the game. He
immediately iced his forearm and took ibuprofen for pain ______________________________________________________
relief. It is now Saturday; although his pain has lessened in
intensity, it is still present. Visual examination shows that his ______________________________________________________
proximal forearm is red and swollen.
3. How would you treat this condition?
QUESTIONS
______________________________________________________
1. What activity of the client caused the injury, and ______________________________________________________
what joint action and muscle was involved in the
activity? ______________________________________________________
______________________________________________________ ______________________________________________________
______________________________________________________ ______________________________________________________
______________________________________________________ ______________________________________________________
______________________________________________________ ______________________________________________________
______________________________________________________ ______________________________________________________
______________________________________________________ ______________________________________________________
CASE STUDY 2
A 34-year-old man comes to your office with pain and 2. Why did you choose those muscles?
stiffness when he flexes and extends his left wrist joint. Using
a pain scale of 0 to 10, the client feels pain at a 6 when he ______________________________________________________
attempts to lift anything heavier than 25 pounds. The client ______________________________________________________
is a mechanic and finds the pain is impeding his work. He
has had this pain for 4 weeks. Two weeks earlier, he started ______________________________________________________
to use over-the-counter pain medication for relief; it worked
but only temporarily. After each workday, his left hand and ______________________________________________________
forearm are significantly sore to the touch. ______________________________________________________
The client was asked if he had been involved in any form
of accident or trauma or whether any change in his lifestyle ______________________________________________________
had occurred. He responded negatively to both questions.
As a follow-up question, the therapist asked, “Have you been
______________________________________________________ 7
doing any unexpected heavy or repetitive lifting?” The client ______________________________________________________
responded that he was involved in moving large pieces of
lumber that were both heavy and bulky a month ago. ______________________________________________________
On physical examination, the client has full and pain-free
active and passive wrist joint range of motion into flexion, 3. How would you treat this client?
radial deviation, and ulnar deviation. However, active and ______________________________________________________
passive extension is limited and he experiences pain in
the anterior forearm with both. With manual resistance to ______________________________________________________
motion, extension and ulnar deviation are negative for pain.
Resisted radial deviation causes mild anterior forearm pain, ______________________________________________________
and resisted flexion causes strong and immediate anterior ______________________________________________________
forearm pain.
______________________________________________________
QUESTIONS
______________________________________________________
1. What muscles would you expect to find tight and
______________________________________________________
painful on palpation assessment?
______________________________________________________
______________________________________________________
______________________________________________________
______________________________________________________
______________________________________________________
______________________________________________________
______________________________________________________
______________________________________________________
______________________________________________________
CHAPTER
Muscles of the Spine
and Rib Cage 8
CHAPTER OUTLINE
Overview of Function: Muscles Intercostal Group—cont'd Scalene Group, 282
of the Spinal Joints, 241 Internal Intercostals Anterior Scalene
Overview of Muscles that Move Levatores Costarum, 262 Middle Scalene
the Mandible, 242 Posterior Scalene
Subcostales and Transversus
Overview of Function: Muscles Thoracis, 264 Suprahyoid Muscles, 284
of the Rib Cage, 242 Diaphragm, 266 Digastric
Anterior Abdominal Wall Stylohyoid
MUSCLES OF THE FULL
Muscles, 268
SPINE AND RIB CAGE Mylohyoid
Rectus Abdominis
Erector Spinae Group, 250 Geniohyoid
External Abdominal Oblique
Iliocostalis Infrahyoid Muscles, 288
Internal Abdominal Oblique
Longissimus Sternohyoid
Transversus Abdominis
Spinalis Sternothyroid
Transversospinalis Group, 252 MUSCLES OF THE NECK Thyrohyoid
Semispinalis Splenius Group, 274 Omohyoid
Multifidus Splenius Capitis
Prevertebral Group, 292
Rotatores Splenius Cervicis
Longus Colli
Interspinales and Suboccipital Group, 276
Intertransversarii, 254 Longus Capitis
Rectus Capitis Posterior
Serratus Posterior Group, 256 Major Rectus Capitis Anterior
Serratus Posterior Superior Rectus Capitis Posterior Rectus Capitis Lateralis
Serratus Posterior Inferior Minor
Quadratus Lumborum, 258 Obliquus Capitis Inferior
Intercostal Group, 260 Obliquus Capitis Superior
External Intercostals Sternocleidomastoid, 280
T he muscles of this chapter are primarily involved

with movement of the trunk, neck, and head at
the spinal joints. Some of these spinal muscles can
by layer, and individual muscle palpation technique
videos are available in the chapter 8 folder on the
Evolve website.
also move the mandible at the temporomandibular
joints (TMJs). In addition, muscles of the rib cage are
presented in this chapter. These muscles move the OVERVIEW OF FUNCTION: MUSCLES
ribs at the sternocostal and costospinal joints. OF THE SPINAL JOINTS
The following is an overview of the structure and
function of the spinal joint muscles presented in this Muscles of the spinal joints may be categorized based
chapter. on three factors: (1) the region of the spine, (2) their
The companion CD at the back of this book allows location, and (3) their depth. Regionally, they may be
you to examine the muscles of this body region, layer divided into three groups: (1) those that run the full
241
length of the spine, (2) those that are primarily located Q The reverse action of ipsilateral rotation of the upper
only in the trunk, and (3) those that are primarily spine relative to the lower spine is contralateral
located only in the neck. Regarding location, they can rotation of the lower spine relative to the upper
be described as being anterior or posterior. Regarding spine, and contralateral rotation of the pelvis if the
their depth, they can be divided based on whether muscle attaches to it.
they are superficial or deep. Generally, the larger, more Q The reverse action of contralateral rotation of the
superficial muscles of the spine are important for cre- upper spine relative to the lower spine is ipsilateral
ating motion; and the deeper, smaller muscles func- rotation of the lower spine relative to the upper
tion to stabilize the spine. spine, and ipsilateral rotation of the pelvis if the
The following general rules regarding actions can muscle attaches to it.
be stated for the functional groups of muscles of the
spinal joints:
Q If a muscle crosses the spinal joints anteriorly with
OVERVIEW OF MUSCLES THAT MOVE
a vertical direction to its fibers, it can flex the trunk, THE MANDIBLE*
neck, and/or head at the spinal joints by moving
Muscles that move the mandible at the TMJs attach to
the insertion (superior attachment) down toward
the mandible. The other attachment of these muscles
8 the origin (inferior attachment) in front.
Q If a muscle crosses the spinal joints posteriorly
is usually considered to be either superior or inferior
to the mandible attachment.
with a vertical direction to its fibers, it can extend
The following general rules regarding actions can
the trunk, neck, and/or head at the spinal joints
be stated for functional groups of muscles that move
by moving the origin (superior attachment) down
the mandible:
toward the insertion (inferior attachment) in Q If a muscle attaches to the mandible and its other
back.
attachment is inferior to the mandibular attach-
Q If a muscle crosses the spinal joints laterally, it
ment, it can depress the mandible at the TMJs.
can perform same-side lateral flexion of the trunk, Q Reverse actions of the suprahyoid muscles of the
neck, and/or head at the spinal joints by moving
hyoid group occur when the mandible is fixed and
the insertion (superior attachment) down toward
the hyoid bone is moved superiorly toward the
the origin (inferior attachment) on that side of the
mandible.
body.
Q Right and left rotators of the spine have a horizon-
tal component to their fiber direction and wrap OVERVIEW OF FUNCTION: MUSCLES
around the body part that they move. OF THE RIB CAGE
Q Reverse actions of these muscles involve the lower
spine (origin; inferior attachment) being moved Muscles that move the rib cage attach to the rib cage.
toward the upper spine (insertion; superior attach- The other attachment of these muscles is usually con-
ment) at the spinal joints. These reverse actions sidered to be either superior or inferior to the rib
usually occur when the client is lying down so the attachment. These muscles may be located anteriorly,
lower attachment is free to move. If the muscle posteriorly, and/or laterally.
attaches onto the pelvis, the reverse action involves The following general rules regarding actions can
movement of the pelvis at the lumbosacral spinal be stated for the functional groups of muscles of the
joint as well. rib cage:
Q The reverse action of flexion of the upper spine rel- Q If a muscle attaches to the rib cage and its other
ative to the lower spine is flexion of the lower spine attachment is superior to the rib cage attachment,
relative to the upper spine, and posterior tilt of the it can elevate the ribs to which it is attached at the
pelvis if the muscle attaches to it. sternocostal and costospinal joints.
Q The reverse action of extension of the upper spine Q If a muscle attaches to the rib cage and its other
relative to the lower spine is extension of the lower attachment is inferior to the rib cage attachment,
spine relative to the upper spine, and anterior tilt of it can depress the ribs to which it is attached at the
the pelvis if the muscle attaches to it. sternocostal and costospinal joints.
Q The reverse action of lateral flexion of the upper Q As a rule, muscles that elevate ribs contract with
spine relative to the lower spine is lateral flexion inspiration and muscles that depress ribs contract
of the lower spine relative to the upper spine, and with expiration.
elevation of the same side of the pelvis (and there-
fore depression of the opposite side of the pelvis) if *The major muscles of mastication (that move the mandible)
the muscle attaches to it. are discussed in Chapter 9, Muscles of the Head.
Posterior View of the
Muscles of the Trunk— External occipital protuberance (EOP)
Superficial and Mastoid process of temporal bone
Intermediate Views Semispinalis capitis
Splenius capitis
Sternocleidomastoid
Splenius capitis
Splenius cervicis
Serratus posterior superior
(Trapezius)
Acromion process
of scapula
8
Inferior angle External

of scapula intercostals
(Latissimus dorsi)
Erector spinae
group

Iliac crest
Serratus posterior inferior

Posterior superior iliac
spine (PSIS) Transversus abdominis
FIGURE 8-1 A, Posterior view of the muscles of the trunk—superficial view on the left and an
intermediate view on the right. Continued
243
Posterior View
of the Muscles
of the Trunk—Deep Views
Suboccipital muscles
C1 transverse process
Longissimus capitis
Semispinalis capitis
Interspinales
1st rib
8
Multifidus
Iliocostalis
Erector
spinae Longissimus
group
Spinalis
7th and 8th external intercostals
12th rib

Intertransversarii
Transversus abdominis
Quadratus lumborum
Multifidus
Posterior superior
iliac spine (PSIS)
Sacrum
FIGURE 8-1, cont'd B, Posterior view of the muscles of the trunk—two deep views, the right
side deeper than the left. The external abdominal oblique has been ghosted in.
244
Anterior View of the Muscles
of the Trunk—Superficial
and Intermediate Views
Sternocleidomastoid
Clavicle
Coracoid process
Rectus abdominis of scapula
External
intercostals
Internal intercostals
External abdominal
oblique (cut)

Iliac crest
Inguinal ligament
FIGURE 8-2 A, Anterior view of the muscles of the trunk—superficial view on the right and an
intermediate view on the left. The muscles of the neck and thigh have been ghosted in. Continued
245
Anterior View
of the Muscles
of the Trunk—Deep Views
6th rib
Internal intercostals
Rectus abdominis Diaphragm
External abdominal oblique (cut)

Quadratus lumborum
Internal abdominal oblique (cut)
Anterior superior
iliac spine (ASIS)
Inguinal ligament
Pyramidalis
FIGURE 8-2, cont'd B, Anterior views of the muscles of the trunk—deep views with the posterior
abdominal wall seen on the left. The muscles of the neck, arm, and thigh have been ghosted in.
246
Anterior View
of the Neck and Upper
Chest Region—Superficial
View
Omohyoid Mandible
Sternohyoid
Sternocleidomastoid
Sternothyroid Scalenes
(Trapezius)
(Platysma)
Omohyoid 8
Manubrium
of sternum
FIGURE 8-3 A, Anterior view of the neck and upper chest region—superficial view. The
platysma has been removed on the left side. Continued
247
Anterior Views of the Neck Mandible
and Upper Chest
Region—Intermediate Mylohyoid
and Deep Views Digastric

Jugular vein
Sternocleidomastoid Hyoid bone

(SCM) (cut)
Common carotid artery
Stylohyoid
Thyrohyoid
Levator scapulae Thyroid cartilage
Sternothyroid
Sternohyoid
Scalenes
Omohyoid
(Trapezius)
8
SCM (cut)
Manubrium
of sternum
Rectus capitis lateralis

Occiput
Longus capitis Rectus capitis anterior
Atlas (C1)
Middle scalene
Longus colli
Posterior scalene
Brachial plexus
Anterior scalene
Subclavian vein
Clavicle
Subclavian
artery 1st rib
FIGURE 8-3, cont'd Anterior views of the neck and upper chest region. B, Intermediate view
with the head extended. The sternocleidomastoid (SCM) has been cut on the right side; the
SCM and omohyoid have been removed and the sternohyoid has been cut on the left side.
C, Deep view. The anterior scalene and longus capitis, as well as the brachial plexus of nerves
and subclavian artery and vein, have been cut and/or removed on the left side. The clavicles
and blood vessels have been ghosted in.
248
Right Lateral Views of the Scalenes
Muscles of the Trunk Sternocleidomastoid
and Neck Region

Omohyoid
Acromion process of scapula (Deltoid)
5th rib
Serratus posterior inferior External abdominal oblique
(Latissimus dorsi)
Iliac crest
FIGURE 8-4 Right lateral view of the muscles of the trunk. The latissimus dorsi and deltoid have
been ghosted in.
Semispinalis capitis
Splenius capitis
Hyoid bone
(Levator scapulae) Sternocleidomastoid
Scalenes Omohyoid
(Trapezius)
Clavicle
Acromion process of scapula
FIGURE 8-5 Right lateral view of the muscles of the neck region.
249
SPINE AND RIB CAGE: Erector Spinae Group

Iliocostalis; Longissimus; Spinalis
Pronunciation ), EE O KOS 4! LIS s LON *)3 I MUS s SPY .! LIS
The erector spinae group is a

large muscle group that runs par-
allel to the spine from the pelvis
to the head. It is composed of
Spinalis three subgroups. From lateral to
Longissimus medial, they are the iliocostalis,
longissimus, and spinalis (Figure
8-6). The erector spinae is most
8
massive in the lumbar and tho-
I racic regions. In the lumbar
region, it is deep to the latissi-
mus dorsi; in the thoracic region,
it is deep to the trapezius and
rhomboids. Very little erector
spinae is present in the neck.
Other than a small amount of
spinalis, its presence in the neck
is the longissimus capitis that is
located more laterally and goes
up to the mastoid process of the
temporal bone. It is deep to the
trapezius, splenius capitis, and
splenius cervicis.
Note: The erector spinae group
Iliocostalis is also known as the sacrospinalis
group. The term paraspinal muscu-
lature is also used to describe the
O erector spinae and the transver-
sospinalis groups together.
FIGURE 8-6 Posterior view of the right erector

spinae group. O, Origin; I, insertion.
WHAT’S IN A NAME?
The name, erector spinae, tells us that this muscle Derivation:
makes the spine erect. (Considering that the spine erector: L. to erect
usually bends forward into flexion, to make it erect spinae: L. thorn (refers to the spine)
would be to perform extension of the spine.)
Chapter 8 Muscles of the Spine and Rib Cage 251
ATTACHMENTS
Q Pelvis

Q Spine, rib cage, and mastoid process of the temporal
bone
ACTIONS
Q Extends the trunk, neck, and head at the spinal joints.
Q Anteriorly tilts the pelvis at the lumbosacral joint and FIGURE 8-7 Palpation of the right erector spinae group as the
extends the lower spine relative to the upper spine. client extends the head, neck, and trunk.
Q Laterally flexes the trunk, neck, and head at the spinal 8
joints.

Q Each of the three subgroups of the erector spinae can
1. Stabilizes the spinal joints.
be further subdivided into three subgroups: (1) iliocostalis
2. Stabilizes the ribs at the sternocostal and costospinal lumborum, thoracis, and cervicis; (2) the longissimus
joints. thoracis, cervicis, and capitis; and (3) the spinalis thoracis,
3. Stabilizes the sacroiliac joint. cervicis, and capitis. Note: The spinalis capitis often blends
with and is therefore considered part of the semispinalis
capitis of the transversospinalis group.
INNERVATION Q Inferiorly, the erector spinae blends into the thick

thoracolumbar fascia.
Q Spinal nerves
Q The erector spinae is
the principal musculature
that works when we
PALPATION bend forward. It con-
tracts eccentrically to
1. The client is prone. Place your palpating finger pads guide our descent
just lateral to the lumbar spine. when we bend forward;
2. Ask the client to extend the trunk; feel for the contrac- it contracts isometrically
when we hold a bent-
tion of the erector spinae musculature in the lumbar
forward posture; and
region (Figure 8-7). Palpate the erector spinae by it contracts concentri-
strumming perpendicularly; palpate inferiorly to its ori- cally when we stand
gin on the pelvis. back up.
3. Now ask the client to extend the trunk, neck, and Q Tight erector spinae musculature pulls the pelvis into
head; continue palpating it superiorly as far as anterior tilt, which then increases the lordotic curve of the
possible toward its mastoid process attachment. lumbar spine.
SPINE AND RIB CAGE: Transversospinalis Group

Semispinalis; Multifidus; Rotatores
Pronunciation 3%- EE SPY .! LIS s MUL 4)& ID US s RO TA 4/ REEZ
The transversospinalis group mus-

I culature is deep and makes up
the mass of musculature that fills
the laminar groove of the spine
between the transverse and spinous
processes. The transversospinalis
Semispinalis muscle group can be divided into
three subgroups: from superficial to
8 deep, they are the semispinalis, the
multifidus, and the rotatores (Figure
8-8). The rotatores attach superiorly
to the vertebrae one to two levels
above the inferior attachment; the
multifidus attaches superiorly to
vertebrae three to four levels above
the inferior attachment; the semispi-
nalis attaches superiorly to vertebrae
five or more levels above the inferior
attachment. The multifidus is the
largest muscle of the low back; the
semispinalis is the largest muscle
of the neck. Of the three subgroups
of the transversospinalis, only the
multifidus attaches onto the pelvis,
Multifidus and only the semispinalis attaches
Rotatores
onto the head. The term paraspinal
musculature is used to describe the
erector spinae and the transversospi-
nalis groups together.
O
FIGURE 8-8 Posterior view of the transversospinalis group.

The semispinalis and multifidus are seen on the right; the
rotatores are seen on the left. O, Origin; I, insertion.
WHAT’S IN A NAME?
Q The name, transversospinalis, tells us that this Derivation:
muscle group attaches from the transverse transverso: L. refers to transverse processes
processes (inferiorly) to the spinous processes spinalis: L. refers to spinous processes
(superiorly).
ATTACHMENTS 5. Once located, follow the semispinalis up to the

attachment on the head by strumming perpendicular
Origin (Proximal Attachment) to the direction of fibers.
Q Pelvis and transverse processes of spine

Q Spinous processes of spine, and the head
ACTIONS
Q Extends the trunk, neck, and head at the spinal joints.
Q Anteriorly tilts the pelvis at the lumbosacral joint and
extends the lower spine relative to the upper spine.
Q Laterally flexes the trunk, neck, and head at the spinal
joints.
FIGURE 8-9 Palpation of the right lumbar multifidus as the client 8
extends and contralaterally rotates (left) the trunk.
Q Contralaterally rotates the trunk and neck at the
spinal joints.
STABILIZATION
1. Stabilizes the spinal joints.
2. Stabilizes the sacroiliac joint.
INNERVATION
Q Spinal nerves
PALPATION
1. The client is prone. Place your palpating finger pads FIGURE 8-10 Palpation of the right semispinalis as the client
just lateral to the spinous processes of the lumbar extends the head and neck.
spine within the laminar groove.
2. Ask the client to extend and rotate the trunk slightly to
the opposite side of the body (contralaterally rotate) TREATMENT CONSIDERATIONS
at the spinal joints. Feel for the contraction of the Q The multifidus is credited,
transversospinalis musculature of the lumbar spine along with the trans-
(Figure 8-9). versus abdominis, as
3. Repeat this procedure superiorly up the spine. being one of the most
important muscles of
4. To palpate the semispinalis group in the cervical core stabilization.
region, have the client prone with the hand in the small
Q Because the multifidus
of the back. Place your palpating fingers over the
attaches inferiorly to the
laminar groove of the cervical spine and ask the client iliac crest and sacrum,
to extend the head and neck slightly at the spinal the transversospinalis
joints. Feeling for the contraction of the semispinalis group can help stabilize
deep to the upper trapezius (Figure 8-10). the sacroiliac joint.
SPINE AND RIB CAGE

Interspinales; Intertransversarii
Pronunciation ). TER SPY .! LEEZ s ). TER TRANS VER 3! RI EYE
The interspinales and intertransversarii are small intrinsic muscles of

the spine that are located between adjacent vertebrae, primarily in the
lumbar and cervical regions. As their names indicate, the interspinales
are located between the spinous processes, and the intertransversarii
are located between the transverse processes (Figure 8-11).
I I
O O
I I
O O
A B
FIGURE 8-11 A, Posterior view of the right and left interspinales. B, Posterior view of the right
intertransversarii. The levatores costarum have been ghosted in on the left. O, Origin; I, insertion.
WHAT’S IN A NAME?
The name, interspinales, tells us that these muscles Derivation:
are located between the spinous processes of the inter: L. between
vertebrae. spinales: L. refers to spinous processes
The name, intertransversarii, tells us that these transversarii: L. refers to transverse processes
muscles are located between the transverse
processes of the vertebrae.
ATTACHMENTS
Interspinales
Q Spinous process

Q Spinous process directly superior
Intertransversarii
Q Transverse process

Q Transverse process directly superior
FIGURE 8-12 Starting position for seated palpation of the
interspinales. 8
ACTIONS
Interspinales
Q Extend the neck and trunk at the spinal joints.
Intertransversarii
Q Laterally flex the neck and trunk at the spinal joints.
STABILIZATION
As a group, the interspinales and intertransversarii
stabilize the cervical and lumbar spinal joints.
INNERVATION
Q Spinal nerves
FIGURE 8-13 Palpation of the interspinales as the client extends

PALPATION the trunk back to anatomic position from a position of slight flexion.
Interspinales
1. The client is seated. Place your palpating finger pads
in the spaces between the spinous processes in the
lumbar region. Place your resistance hand on the Q The intertransversarii are considered
client’s upper trunk (Figure 8-12). to be primarily important as
stabilizing postural muscles or
2. Ask the client to flex slightly forward. Feel for the inter-
as proprioceptive organs (not as
spinous muscles between the spinous processes. movers of the spine), thereby
3. From this position of flexion, ask the client to extend providing precise monitoring
back to anatomic position, and feel for the contrac- of spinal joint positions.
tion of the interspinales muscles. If desired, resistance Q The interspinales and
can be given to the client’s trunk extension with your intertransversarii vary
resistance hand (Figure 8-13). in location. Sometimes
4. This procedure can be repeated for other interspina- they are found at spinal joint
levels other than those listed
les muscles between other spinous processes.
in this textbook; sometimes they are
absent at some of their usual locations.
Intertransversarii Q Essentially, the intertransversarii do not exist in the thoracic
1. The intertransversarii are small and very deep and region. The levatores costarum and the intercostals
therefore difficult to palpate and discern from adjacent are considered to be homologous with the two sets of
musculature. intertransversarii in the thoracic region.
SPINE AND RIB CAGE: Serratus Posterior Group

Serratus Posterior Superior; Serratus Posterior Inferior
Pronunciation SER ! TUSPOS 4%% RI ORSUE 0%% RI OR s SER ! TUSPOS 4%% RI ORIN &%% RI OR
The serratus posterior group is composed of two muscles: the serratus

posterior superior and the serratus posterior inferior (Figure 8-14).
These muscles attach to ribs. The serratus posterior superior is deep to
the trapezius and rhomboids; the serratus posterior inferior is deep to
the latissimus dorsi.
A B
FIGURE 8-14 A, Posterior view of the right serratus posterior superior. The splenius capitis has
been ghosted in on the right. B, Posterior view of the serratus posterior inferior bilaterally. The
latissimus dorsi has been ghosted in on the left side. O, Origin; I, insertion.
WHAT’S IN A NAME?
The name, serratus posterior, tells us that these Derivation:
muscles have a serrated appearance and are serratus: L. notching
posterior to the serratus anterior. The serratus posterior: L. behind, toward the back
posterior superior is superior to the serratus posterior superior: L. above
inferior. inferior: L. below
Serratus Posterior Superior The serratus posterior superior and inferior are thin
muscles that are located deep to other muscles; there-
Origin (Superior Attachment) fore they are difficult to palpate and discern. If palpa-
Q Spinous processes of C7-T3 tion is done, the client is prone.
Insertion (Inferior Attachment)

Serratus Posterior Superior
Q Ribs two through five
1. Place your palpating finger pads in the region of the
upper rhomboids.
Serratus Posterior Inferior 2. Have the client take in a moderately deep breath. Feel
for the contraction of the serratus posterior superior.
Origin (Inferior Attachment)
Discerning the serratus posterior superior from the
Q Spinous processes of T11-L2 overlying rhomboids and trapezius is very challenging.
Insertion (Superior Attachment) 8

Q Ribs nine through twelve Serratus Posterior Inferior
1. Place your palpating finger pads in the upper lumbar
region, lateral to the erector spinae.
ACTIONS 2. Ask the client to exhale. Feel for the contraction
of the serratus posterior superior by strumming
The serratus posterior muscles move ribs at the sterno- perpendicular to its fibers. Discerning the serratus
costal and costospinal joints. posterior inferior from the overlying latissimus dorsi is
very challenging.
Serratus Posterior Superior
Q Elevates ribs two through five.
Q The serrated appearance
Serratus Posterior Inferior of the serratus posterior
Q Depresses ribs nine through twelve. superior and inferior
comes from attaching
onto separate ribs, which
STABILIZATION creates the notched look
Stabilizes the rib cage. of a serrated knife.
Q Stabilizing the lower
ribs is an important
function of the serratus
INNERVATION posterior inferior. Its
force of depression of
Q Intercostal nerves (serratus posterior superior)
the lower ribs stabilizes them
Q Subcostal nerve and intercostal nerves (serratus from elevating when the diaphragm contracts and pulls
posterior inferior) superiorly on them.
SPINE AND RIB CAGE

Quadratus Lumborum (QL)
Pronunciation KWOD 2!9 TUSLUM "/2 UM
The quadratus lumborum (QL) is a square-shaped

muscle in the low back that attaches to the spine,
rib cage, and pelvis (Figure 8-15). It is deep to the
erector spinae.
ATTACHMENTS
8
Q Twelfth rib and the transverse processes of L1-L4

Q Posterior iliac crest
ACTIONS
O
The quadratus lumborum moves the trunk at the spi-
nal joints, the pelvis at the lumbosacral joint, and the
twelfth rib at the costospinal joint.
Quadratus
lumborum Q Elevates the same-side pelvis.
Q Anteriorly tilts the pelvis and extends the lower lumbar
spine relative to the upper lumbar spine.
I Q Extends the trunk.
Q Laterally flexes the trunk.
Q Depresses the twelfth rib.
STABILIZATION
Stabilizes the pelvis, lumbar spinal joints, and twelfth rib.
FIGURE 8-15 Posterior view of the quadratus lumborum bilater-
ally. The erector spinae group has been ghosted in on the left
side. O, Origin; I, insertion.
INNERVATION
Q Lumbar plexus
WHAT’S IN A NAME?
PALPATION
The name, quadratus lumborum, tells us that this
muscle is shaped somewhat like a square and is 1. The client is prone. Place your palpating finger pads
located in the lumbar (i.e., lower back) region. just lateral to the lateral border of the erector spinae in
Derivation: the lumbar region.
Note: Placing the fingers of other hand on the palpating
lumborum: L. loin (low back)
fingers for extra support can be helpful.
FIGURE 8-16 A, Palpation of the right quadratus lumborum

as the client elevates the right side of the pelvis. The outline
of the right erector spinae group has been ghosted in. B, Once
the quadratus lumborum has been located, palpate in all
three directions toward the rib, transverse process, and iliac
attachments.
Q When working on the quadratus lumborum, you can position
2. First locate the lateral border of the erector spinae the client either prone, supine, or side lying. However,
musculature. (To do so, ask the client to raise the because much of this muscle is deep to the massive erector
head and upper trunk from the table.) Then place spinae musculature, it must be accessed with palpatory
your palpating finger just lateral to the lateral border of pressure from lateral to medial (i.e., come in from the side).
the erector spinae. Q Keep in mind that the quadratus lumborum is not the only
3. Direct palpating pressure medially, deep to the erector muscle in the lateral lumbar region and should not be
blamed for all the pain in this area. The nearby erector spinae
spinae musculature, and feel for the quadratus
musculature is also likely to develop tension and pain.
lumborum.
Q If the quadratus lumborum is
4. To engage the quadratus lumborum, ask the client to
tight, it can pull up on the
elevate the pelvis on that side at the lumbosacral joint pelvic bone, causing the
and feel for its contraction (Figure 8-16, A). iliac crest on that side to
elevate. This elevation can be
Note: The pelvis should move along the plane of the table seen during the postural
toward the head; in other words, the pelvis should not lift up assessment examination.
in the air, away from the table. Q The quadratus lumborum is
important for stabilizing the
5. Once located, palpate medially and superiorly
twelfth rib when the
toward the twelfth rib, medially and inferiorly toward diaphragm contracts during
the iliac crest, and directly medially toward the inspiration. Stabilization
transverse processes of the lumbar spine (Figure increases the efficiency of the
8-16, B). diaphragm during breathing.
SPINE AND RIB CAGE: Intercostal Group

External Intercostals; Internal Intercostals
Pronunciation %+3 TURN ALIN TER +/3 TALS s ). TURN ALIN TER +/3 TALS
The intercostal group is composed of the external intercostals and

the internal intercostals (Figure 8-17). These muscles are located
in the anterior, lateral, and posterior thoracic region of the trunk.
Depending on the specific location, they may be deep to other
muscles or they may be superficial and easily palpable. The fiber
directions of these two muscle groups are perpendicular to each
other. The fiber direction of the external intercostals is the same
as the fiber direction of the external abdominal oblique; the
8 fiber direction of the internal intercostals is the same as the fiber
direction of the internal abdominal oblique.
O
I I
O
A B
FIGURE 8-17 Views of the right intercostals. A, Anterior view of the external intercostals. B, Posterior
view of the internal intercostals. O, Origin; I, insertion.
WHAT’S IN A NAME?
The name, intercostals, tells us that these muscles Derivation:
are located between the ribs in the intercostal spaces. inter: L. between
The external intercostals are external (superficial) to costals: L. refers to the ribs
the internal intercostals. external: L. outside
internal: L. inside
ATTACHMENTS
Origin/Insertion (Superior/Inferior Attachments)
Q In the intercostal spaces of ribs one through twelve
ACTIONS
Q The intercostals move the ribs at the sternocostal and
costospinal joints and move the trunk at the spinal
joints.
External Intercostals
FIGURE 8-18 Palpation of right intercostal muscles between the
Q Elevate ribs two through twelve. ribs in the lateral trunk.
Q Rotate the trunk contralaterally. 8
Internal Intercostals TREATMENT CONSIDERATIONS

Q Controversy exists over the exact
Q Depress ribs one through eleven.
actions of the intercostals.
Q Rotate the trunk ipsilaterally. However, it is clear that
they are involved in
STABILIZATION respiration. Therefore the
intercostals should be
Stabilize the rib cage. addressed in any client
who has a respiratory
condition, especially a
chronic one such as
INNERVATION asthma, emphysema,
or bronchitis, or simply
Q Intercostal nerves a chronic cough.
Q Athletes may also greatly benefit from having these muscles
worked on because of the great demand for respiration
PALPATION during exercise.
Q The intercostals are also involved in fixation (i.e., stabilization)
1. The client is side lying. Place your palpating finger of the rib cage during other movements of the body.
pads in the intercostal spaces (between ribs) in the
Q Anteriorly the internal intercostals are located in the spaces
lateral trunk (Figure 8-18).
between the costal cartilages; the external intercostals are
2. To locate an intercostal space, feel for the hard not.
texture of the ribs in the lateral trunk and then drop
Q The intercostal muscles are the meat that is eaten when one
your palpating fingers into the soft intercostal space eats ribs or spare ribs.
between them.
3. Once located, palpate in the intercostal space as far
posteriorly and anteriorly as possible. The presence
of breast tissue in female clients makes it difficult to
access fully the intercostals anteriorly.
Note: Discerning between the external and internal inter-

costals is usually not possible.
SPINE AND RIB CAGE

Levatores Costarum
Pronunciation LE VA 4/ REZSINGULARLE 6!9 TOR KOS 4!2 UM
The levatores costarum are small muscles

located in the thoracic region deep to
the erector spinae musculature; they run
from the vertebrae to the ribs. The lower
levatores costarum have two slips of tissue
at each level; the shorter ones are called
levatores costarum breves and the longer
ones are called levatores costarum longi
8 (Figure 8-19).
O
ACTIONS
I Q Elevate the ribs at the sternocostal and costospinal
joints.
O
STABILIZATION
Stabilize the thoracic spinal joints and costospinal joints.
I
INNERVATION
Q Spinal nerves
FIGURE 8-19 Posterior view of the right levatores costarum.
PALPATION
WHAT’S IN A NAME? 1. The client is prone. Place your palpating finger pads
on the erector spinae musculature over the angles of
The name, levatores costarum, tells us that these
the ribs.
muscles elevate the ribs.
Derivation: 2. Ask the client to breathe in and out slowly and
levator: L. lifter deeply. Try to feel for the contraction of the levatores
costarum: L. refers to the ribs costarum.
Note: The levatores costarum are small and very deep.

Palpating and discerning them from the adjacent
ATTACHMENTS musculature is extremely difficult, if not impossible.
Origin (Superior Attachment)

Q Transverse processes of C7-T11
Insertion (Inferior Attachment) Q Some sources state that the primary function of the
Q Ribs one through twelve levatores costarum is to stabilize the spinal joints and ribs.
Notes
SPINE AND RIB CAGE

Subcostales; Transversus Thoracis
Pronunciation SUB KOS 4!, EEZ s TRANS 6%2 SUSTHOR !3 IS
The subcostales and transversus thoracis are deep

muscles, located on the internal side of the rib cage.
The subcostales are located posteriorly; the transversus
thoracis is located anteriorly (Figure 8-20).
I
O
A B
FIGURE 8-20 A, Posterior view of the subcostales bilaterally. The internal intercostals have been
ghosted in on the left side. B, Anterior view of the right transverses thoracis. O, Origin; I, insertion.

The name, subcostales, tells us that these muscles Subcostales
are “under” (i.e., deep to) the ribs.
The name, transversus thoracis, tells us that this Origin (Inferior Attachment)
muscle runs transversely across the thoracic region. Q Ribs ten through twelve
Derivation:
sub: L. under Insertion (Superior Attachment)
costales: L. refers to the ribs Q Ribs eight through ten
transversus: L. running transversely
thoracis: Gr. refers to the thorax (chest)
Transversus Thoracis PALPATION

Origin (Medial Attachment) The subcostales and transversus thoracis are deep to
Q Internal surfaces of the sternum, the xiphoid process, the rib cage and extremely challenging if not impossi-
and the adjacent costal cartilages ble to palpate and discern from adjacent musculature.
Insertion (Lateral Attachment) Subcostales

Q Internal surface of costal cartilages two through six 1. Place your palpating finger pads just lateral to the
lateral border of the erector spinae in the posterior
intercostal spaces between ribs eight to twelve.
ACTIONS Feel for the subcostales deep to the intercostal
musculature.
The subcostales and transversus thoracis move the ribs
at the sternocostal and costospinal joints.
Transversus Thoracis
Subcostales 1. Place your palpating finger pads in the anteromedial
intercostal spaces between ribs two to six, just lateral 8
Q Depress ribs eight through ten.
to the sternum, or immediately lateral to the xiphoid
process of the sternum. Feel for the transversus
Transversus Thoracis thoracis.
Q Depresses ribs two through six.

Q The primary function of the subcostales might be to stabilize
Subcostales ribs eight through ten by stopping them from elevating,
Q Stabilizes the lower ribs. which could help stabilize the rib cage attachment of the
diaphragm, enabling the diaphragm to pull more efficiently
on its dome (central tendon). This function would make the
Transversus Thoracis subcostales important as accessory muscles of inspiration.
Q Stabilizes the rib cage and sternum. Q Because a muscle cannot be palpated and discerned
from adjacent musculature does not mean that pressure
cannot be translated into it. Moderate-to-deeper pressure
INNERVATION can be used successfully to work these muscles where
the subcostales and transversus thoracis are accessible
Q Intercostal nerves between the ribs.
SPINE AND RIB CAGE

Diaphragm
Pronunciation $) A FRAM
The diaphragm is a broad flat muscle

that separates the thoracic cavity from the
abdominal cavity. It attaches inferiorly
and peripherally to the rib cage, and has
an aponeurotic central tendon called
I the dome that is superiorly and centrally
located (Figure 8-21). The diaphragm
is the principle muscle of respiration. It
8 contracts when we breathe in; it relaxes
when we breathe out.
O O Central
tendon
(insertion)
Aorta
A
Left medial
Psoas major arcuate
FIGURE 8-21 Views of the ligament
diaphragm. A, Anterior view.
Quadratus lumborum
B, Inferior view. The psoas Left lateral
major, quadratus lumborum, arcuate
and transversus abdominis Left crus ligament
are shown on the right side. L3
O, Origin; I, insertion. B Right crus

The name, diaphragm, tells us that this muscle is Q Increases the volume of (i.e., expands) the thoracic
a partition (it separates the thoracic cavity from the cavity.
abdominal cavity).
Derivation: STABILIZATION
diaphragm: Gr. partition
Stabilizes the trunk, including the joints of the lower rib
cage and the thoracic and lumbar spinal joints.
ATTACHMENTS
INNERVATION
Origin (Inferior/Peripheral Attachment)
Q Phrenic nerve
Q Internal surfaces of the rib cage and sternum, and the
spine
Insertion (Superior/Central Attachment)

Q Central tendon (dome) of the diaphragm
A B
FIGURE 8-22 Palpation of the diaphragm. A, Palpation of the right side of the diaphragm as the
client slowly exhales. B, Close-up showing palpation of the diaphragm by curling the fingers
around the rib cage so that the finger pads are oriented against the muscle.
PALPATION farther, the rib cage attachment

lifts up, increasing the
1. The client is supine with a roll under the knees to anterior-to-posterior
flex the thighs at the hip joint. Place your palpating diameter of the
fingers curled under the inferior margin of the anterior thoracic cavity to
enable the lungs to
rib cage.
further fill with air. Because
2. Ask the client to take in a deep breath and then slowly this causes the rib cage to move
exhale. As the client exhales, curl your fingertips under outward, this is called chest breathing.
(inferior and then deep to) the rib cage. Feel for the Q A number of openings in the diaphragm allow passage of
diaphragm on the internal surface of the rib cage with structures between the thoracic and abdominal cavities. The
your finger pads (Figure 8-22). largest openings are for the esophagus, aorta, and inferior
3. Repeat this procedure anteriorly and posteriorly as far vena cava.
as possible on both sides of the rib cage. Q The diaphragm is unusual in that it is under both conscious
control and unconscious control. More specifically,
Note: Assessment of the diaphragm should only be made contraction of the diaphragm is under constant unconscious
when it is totally relaxed, which occurs at the end of the regulation by the brainstem. However, we routinely override
exhalation. this brainstem control whenever we choose to sing, talk,
sigh, hold our breath, or otherwise consciously change our
breathing pattern.
Q A hiatal hernia is when part of the stomach herniates
TREATMENT CONSIDERATIONS (ruptures) through the diaphragm into the thoracic cavity.
Q When the diaphragm contracts, usually the rib cage Q When the diaphragm contracts, the lungs inflate with air and
attachment is more fixed; consequently, the central dome the thoracic cavity becomes more rigid. Further, because
drops down. This increases the superior-to-inferior diameter the diaphragm drops down against the contents of the
of the thoracic cavity to enable the lungs to fill with air. abdominal cavity, the abdominal cavity is also compressed,
Because this pushes the becoming more rigid. The result is that core stability is
belly out, it is often increased, including the thoracic and lumbar spinal joints.
called belly breathing. This is the reason why people intuitively take in and hold a
Once the dome deep breath when performing a joint action that requires
cannot drop any great strength.
SPINE AND RIB CAGE: Anterior Abdominal Wall Muscles

Rectus Abdominis; External Abdominal Oblique;
Internal Abdominal Oblique; Transversus Abdominis
Pronunciation 2%+ TUSAB $/- I NIS s %+3 TURN ALAB $/- IN ALO ",%%+ s
IN 452. ALAB $/- IN ALO ",%%+ s TRANS 6%2 SUSAB $/- I NIS
Four muscles make up the anterior

abdominal wall: (1) rectus abdominis,
(2) external abdominal oblique, (3) inter-
nal abdominal oblique, and (4) transver-
sus abdominis (Figure 8-23). The rectus
abdominis is superficial in the anteromedial
I
8 abdominal wall. The other three are located
in the anterolateral abdominal wall (they
also reach around as far as the posterior
abdominal wall). Of these three, the exter-
nal abdominal oblique is the most superfi- Rectus
abdominis
cial; the internal abdominal oblique is deep
to it; and the transversus abdominis is the
deepest of the three.
FIGURE 8-23 A, Rectus abdominis—anterior view bilaterally. The

external abdominal oblique has been ghosted in on the left. B, Right O
external abdominal oblique—anterior view. C, Right external abdom-
inal oblique—right lateral view. A
External abdominal
oblique
O
B C
I
I
Internal abdominal
oblique 8
O
O
D E
O I
O I
F G
FIGURE 8-23, cont'd D, Right internal abdominal oblique—anterior view. E, Right internal abdominal
oblique—right lateral view. F, Right transversus abdominis—anterior view. G, Right transversus
abdominis—right lateral view. O, Origin; I, insertion.
Turn page to 'more.

WHAT’S IN A NAME? Insertion (Distal Attachment)

Q Lower three ribs (ten through twelve) and the
The name, rectus abdominis, tells us that this muscle abdominal aponeurosis
runs straight up the abdomen.
The name, external abdominal oblique, tells us
that this muscle is located externally in the abdomen Transversus Abdominis
(superficial to the internal abdominal oblique) and its
fibers are oriented obliquely. Origin (Proximal Attachment)
The name, internal abdominal oblique, tells us that Q Inguinal ligament, iliac crest, thoracolumbar fascia,
this muscle is located internally in the abdomen (deep and lower costal cartilages
to the external abdominal oblique) and its fibers are
oriented obliquely. Insertion (Distal Attachment)
The name, transversus abdominis, tells us that this Q Abdominal aponeurosis
muscle runs transversely across the abdomen.
Derivation:
8 rectus: L. straight ACTIONS
oblique: L. slanting, diagonal
transversus: L. running transversely
Q The muscles of the anterior abdominal wall move
abdominis: L. refers to the abdomen the trunk at the spinal joints and the pelvis at the
external: L. outside lumbosacral joint.
internal: L. inside Q The rectus abdominis and the abdominal obliques all
flex and laterally flex the trunk and also posteriorly tilt
the pelvis.
Rectus Abdominis
ATTACHMENTS Q Flexes the trunk.
Rectus Abdominis Q Posteriorly tilts the pelvis and flexes the lower trunk
relative to the upper trunk.
Origin (Proximal Attachment) Q Laterally flexes the trunk.
Q Pubis
Insertion (Distal Attachment) External Abdominal Oblique

Q Xiphoid process and the cartilage of ribs five through Q Flexes the trunk.
seven
Q Posteriorly tilts the pelvis and flexes the lower trunk
relative to the upper trunk.
Q Contralaterally rotates the trunk.
Q Anterior iliac crest, pubic bone, and abdominal
aponeurosis Internal Abdominal Oblique
Q Flexes the trunk.
Insertion (Distal Attachment) Q Posteriorly tilts the pelvis and flexes the lower trunk
Q Lower eight ribs (ribs five through twelve) relative to the upper trunk.
Q Ipsilaterally rotates the trunk.
Internal Abdominal Oblique
Q Inguinal ligament, iliac crest, and thoracolumbar Transversus Abdominis
fascia Q Compresses abdominopelvic cavity.
STABILIZATION 2. Ask the client to rotate the trunk to the opposite

side of the body (contralateral rotation) and slightly
Stabilize the lumbar spinal joints, pelvis, and rib cage.
flex the trunk; feel for the contraction of the external
abdominal oblique (Figure 8-25).
3. Feel for the diagonal orientation of the external
INNERVATION abdominal oblique fibers by strumming perpendicular
to them. Continue palpating the external abdominal
Q Intercostal nerves
oblique toward its superior and inferior attachments.
PALPATION Internal Abdominal Oblique

All muscles of the anterior abdominal wall are palpated 1. Repeat the same procedure; this time, however, ask
with the client prone with a small roll under the knees. the client to ipsilaterally rotate the trunk and to flex the
trunk slightly (Figure 8-26).
Rectus Abdominis 8
1. The client is supine with a small roll under the knees.
Place your palpating finger pads just off center of the
midline of the abdomen.
2. Ask the client to flex the trunk slightly at the spinal
joints (slightly curl the trunk upward), and feel for the
contraction of the rectus abdominis (Figure 8-24).
3. With the rectus abdominis contracted, strum laterally
and medially (perpendicularly) across its fibers to
locate its lateral and medial borders. Continue
palpating to the superior attachment (origin) and then
to the inferior attachment (insertion) by strumming
perpendicularly across the fibers.

1. Place your palpating finger pads on the anterolateral FIGURE 8-25 Palpation of the right external abdominal oblique
abdominal wall between the iliac crest and the lower as the client flexes and contralaterally (left) rotates the trunk
against gravity.
ribs. (Be sure you are lateral to the rectus abdominis.)
FIGURE 8-24 Palpation of the right rectus abdominis as the FIGURE 8-26 Palpation of the right internal abdominal oblique as
client flexes the trunk against gravity. Palpation should be done the client flexes and ipsilaterally (right) rotates the trunk against
by strumming perpendicular to the fibers as shown. gravity.
Turn page to 'more.

Q If you were to put

Transversus Abdominis your hand into a coat
1. With palpating finger pads on the anterolateral pocket, your fingers
abdomen, ask the client to compress the abdominal would be pointing
contents by forcefully breathing out. Feel for the along the direction
contraction of the transversus abdominis. of the fibers of the
external abdominal
Note: The transversus abdominis is deep to the other antero- oblique on that side.
For this reason, the
lateral abdominal wall muscles and extremely difficult to
external abdominal
discern from them because they also contract when com- oblique muscles are
pressing the abdominal contents. sometimes called
the pocket muscles.
Q The transversus abdominis
is sometimes called the
TREATMENT CONSIDERATIONS corset muscle because it
Q All muscles of the abdominal wall compress against the wraps around the abdomen
abdominal contents and help create a flat abdomen. like a corset and, similar
8 to a corset, it functions to
Q Stabilizing the lumbar spinal joints and the pelvis is stabili- hold in the abdomen.
zation of the core of the body. Although the transversus
abdominis is best known for this function, the other abdomi-
nal muscles can assist.
Q The abdominal aponeurosis is actually the midline
aponeurosis of the three anterolateral abdominal wall
muscles (external and internal abdominal obliques and
the transversus abdominis). The abdominal aponeurosis
is also known as the rectus sheath because it envelops or
ensheathes the rectus abdominis. HELP!
I can’t
Q Three fibrous bands known as get this
tendinous inscriptions packet
transect the rectus
open!
abdominis muscles K
8 PAC G S
and divide each one STRON
into four sections or MINTS
boxes. For this reason,
the rectus abdominis muscles
in a well-developed individual
are often known as the
eight-pack (8-pack) muscle.
(Actually, it is more often
incorrectly labeled the six-pack [6-pack] muscle, because
six of the eight compartments are more visible.)
Notes
SPINE AND RIB CAGE: Splenius Group

Splenius Capitis; Splenius Cervicis
Pronunciation 30,%% NEE US+!0 I TIS s 30,%% NEE US3%2 VI SIS
Two splenius muscles are in the upper trunk and neck: (1) splenius
capitis and (2) splenius cervicis. The splenius capitis attaches
superiorly (inserts) onto the head; the splenius cervicis attaches
superiorly (inserts) onto the cervical spine, hence their names
(Figure 8-27). They are located deep to the trapezius and rhom-
boids; however, the splenius capitis is superficial in the posterior
triangle of the neck (a triangular region bordered by the upper
trapezius, sternocleidomastoid, and clavicle).
8
I
I
Splenius capitis Splenius cervicis
A B
FIGURE 8-27 A, Posterior view of the right splenius capitis. The trapezius has been ghosted in.
B, Posterior view of the right splenius cervicis. The splenius capitis has been ghosted in. O, Origin;
I, insertion.

The name, splenius capitis, tells us that this muscle Splenius Capitis
is shaped like a bandage (a narrow rectangle) and
attaches onto the head. Origin (Proximal Attachment)
The name, splenius cervicis, tells us that this Q Nuchal ligament from C3-C6 and the spinous
muscle is shaped like a bandage (a narrow rectangle) processes of C7-T4
and attaches onto the cervical spine (the neck).
Derivation: Insertion (Distal Attachment)
splenius: Gr. bandage Q Mastoid process of the temporal bone and the
capitis: L. refers to the head occipital bone
cervicis: L. refers to the cervical spine
Splenius Cervicis
Q Spinous processes of T3-T6

Q Transverse processes of C1-C3
ACTIONS
The splenius capitis and cervicis have the same actions
on the neck at the spinal joints; the capitis also has
these actions on the head at the atlanto-occipital joint.
Splenius Capitis 8
Q Extends the head and neck.
Q Laterally flexes the head and neck.
Q Ipsilaterally rotates the head and neck. FIGURE 8-28 Palpation of the right splenius capitis in the posterior
triangle of the neck as the client extends the head and neck
against resistance. The upper trapezius has been ghosted in.
Splenius Cervicis
Q Extends the neck.
Q Laterally flexes the neck. 4. While asking the client to alternately extend the head
and neck against gentle resistance and then relax,
Q Ipsilaterally rotates the neck.
feel for the contraction and relaxation of the splenius
capitis deep to the upper trapezius. Continue palpat-
STABILIZATION ing the splenius capitis deep to the trapezius as far
1. Both splenius muscles stabilize the cervical and inferiorly as possible.
upper thoracic vertebrae.
2. The splenius capitis also stabilizes the head. Splenius Cervicis
1. The splenius cervicis is deep to other musculature for
its entire course; therefore palpating and discerning it
INNERVATION can be difficult, especially from the splenius capitis.
2. If palpation is attempted, use the same protocol as
Q Cervical spinal nerves
that for the splenius capitis and feel for the splenius
cervicis immediately lateral to the splenius capitis.
PALPATION
Splenius Capitis TREATMENT CONSIDERATIONS
Q The left and right splenius capitis
1. The client is seated with the head and neck ipsilater-
muscles bilaterally form a
ally rotated. Place your palpating finger pads at the
V shape. Because of their
upper aspect of the posterior triangle of the neck just V shape, the left and right
inferior to the occiput and just posterior to the sterno- splenius capitis muscles
cleidomastoid muscle (see page 280). Place your are sometimes known as
resistance hand on the back of the client’s head. the golf tee muscles.
2. With the client’s head and neck ipsilaterally rotated, Q The splenius capitis
resist the client from extending the head and neck and splenius cervicis
at the spinal joints. Feel for the contraction of the often blend together.
splenius capitis (Figure 8-28). By definition, any fibers
that attach superiorly onto
3. Strum perpendicular to the fibers of the splenius capitis the head are defined as splenius
in the posterior triangle, working your way downward, capitis and any fibers that attach superiorly onto the cervical
until you reach the border of the upper trapezius. spine are defined as splenius cervicis.
SPINE AND RIB CAGE: Suboccipital Group

Rectus Capitis Posterior Major; Rectus Capitis Posterior Minor;
Obliquus Capitis Inferior; Obliquus Capitis Superior
Pronunciation 2%+ TUS+!0 I TISPOS 4%% RI OR-!9 JOR s
2%+ TUS+!0 I TISPOS 4%% RI OR-9 NORs
OB ,%% KWUS+!0 I TISIN &%% RI OR s OB ,%% KWUS+!0 I TISSUE 0%% RI OR
The suboccipital group is composed of four small deep muscles

whose bellies are located directly inferior to the occiput, hence the
name. These muscles are (1) rectus capitis posterior major,
(2) rectus capitis posterior minor, (3) obliquus capitis inferior,
and (4) obliquus capitis superior (Figure 8-29).
8
I I
O
Rectus capitis
O posterior minor
Rectus capitis
posterior major
A B
I
O Obliquus capitis
superior
O
Obliquus capitis
inferior
C D
FIGURE 8-29 Posterior views bilaterally. A, The rectus capitis posterior major. The rectus capitis
posterior minor has been ghosted in on the left. B, The rectus capitis posterior minor. The rectus
capitis posterior major has been ghosted in on the left. C, The obliquus capitis inferior. The
obliquus capitis superior has been ghosted in on the left. D, The obliquus capitis superior. The
obliquus capitis inferior has been ghosted in on the left. O, Origin; I, insertion.
WHAT’S IN A NAME? Obliquus Capitis Superior

The names, rectus capitis posterior major and minor, Origin (Proximal Attachment)
tell us that they attach onto the head and that the Q Transverse process of the atlas (C1)
fibers of these muscles run straighter than the two
obliquus capitis suboccipital muscles. They also tell Insertion (Distal Attachment)
us that the major is larger than the minor. Q Occiput
The names, obliquus capitis inferior and superior,
tell us that they attach onto or near the head and
that the fibers of these muscles run obliquely in
comparison to the two rectus capitis posterior
ACTIONS
suboccipital muscles. They also tell us that the inferior The suboccipital muscles move the head at the atlanto-
is located inferiorly to the superior. occipital joint (AOJ) or move the atlas at the atlanto-
Derivation:
axial joint (AAJ).
capitis: L. refers to the head
posterior: L. behind, toward the back Rectus Capitis Posterior Major
8
rectus: L. straight Q Extends the head at the AOJ.
obliquus: L. oblique/slanting/diagonal
major: L. larger
minor: L. smaller Rectus Capitis Posterior Minor
inferior: L. below Q Protracts the head at the AOJ.
superior: L. above
Obliquus Capitis Inferior
Q Ipsilaterally rotates the atlas at the AAJ.
ATTACHMENTS Obliquus Capitis Superior

Q Protracts the head at the AOJ.
Rectus Capitis Posterior Major
Origin (Proximal Attachment) STABILIZATION
Q Spinous process of the axis (C2) Suboccipital Group
1. Stabilizes the head and atlas at the AOJ.
2. Stabilizes the AAJ.
Q Occiput
INNERVATION
Rectus Capitis Posterior Minor
Q Suboccipital nerve
Q Posterior tubercle of the atlas (C1)
PALPATION
Q Occiput
Rectus Capitis Posterior Major
1. The client is supine. Place your palpating finger
pads just superior and slightly lateral to the spinous
process of C2.
Obliquus Capitis Inferior
2. Find the spinous process of C2. Then palpate just
Origin (Proximal Attachment) superolateral to it and feel for the rectus capitis poste-
Q Spinous process of the axis (C2) rior major by strumming perpendicular to its fibers.
3. Continue strumming perpendicularly, following it
Insertion (Distal Attachment) superolaterally toward its occipital attachment
Q Transverse process of the atlas (C1) (Figure 8-30).
Turn page to 'more.

FIGURE 8-30 Palpation of the right rectus capitis posterior major FIGURE 8-31 Palpation of the right rectus capitis posterior minor
between the spinous process of the axis (C2) and the occiput. between the posterior tubercle of the atlas (C1) and the occiput.
Rectus Capitis Posterior Minor TREATMENT CONSIDERATIONS

1. Repeat the same steps but start just superolateral to Q As a group, the suboccipital muscles are generally thought
the posterior tubercle of C1. Strum perpendicular to to be primarily important as postural stabilization muscles,
locate the rectus capitis posterior minor; then follow providing fine control of head posture. They are also rich in
toward the occipital attachment (Figure 8-31). Asking receptors for proprioception.
the client to protract the head at the AOJ anteriorly to Q The rectus capitis posterior minor has a fascial connective
engage the muscle may be helpful. tissue attachment into the dura mater. Although tightness of
any of the posterior cervical musculature may cause tension
Obliquus Capitis Inferior headaches, given this dura mater attachment, a tight rectus
capitis posterior minor may be
1. Palpate between the spinous process of C2 and the especially involved. THE MI
transverse process of C1, strumming perpendicular SSIN
Q Given their action of protraction G LINK
to the fibers. Asking the client to rotate ipsilaterally
of the head at the AOJ, a
the head against gentle resistance may be helpful to
engage the muscle.
tight rectus capitis posterior
minor and obliquus capitis
?
superior can contribute
Obliquus Capitis Superior to a posture of the head
being held anteriorly; in
1. This muscle is very challenging to palpate and discern other words, protracted.
from adjacent musculature. Feel for it just lateral to
Q A certain amount of caution
the superior attachment of the rectus capitis posterior
must be exercised when palpating and pressing into
major; if felt, try to continue palpating it inferiorly by the region known as the suboccipital triangle (bounded
strumming perpendicular to it. by the rectus capitis posterior major and the two
obliquus capitis muscles), because of the presence of
the vertebral artery and suboccipital nerve. The greater
occipital nerve is also located nearby.
Notes
SPINE AND RIB CAGE

Sternocleidomastoid (SCM)
Pronunciation 34%2 NO +,) DO -!3 TOYD
The sternocleidomastoid
(SCM) is a superficial muscle
of the neck. It has two heads,
a sternal head and clavicular
8 I head, which blend and
attach superiorly onto the
head (Figure 8-32).
Sternal head ATTACHMENTS

Clavicular head
Q Sternal head: manubrium of the sternum
Q Clavicular head: medial clavicle
O
Q Mastoid process of the temporal bone
FIGURE 8-32 Lateral view of the right sternocleidomastoid. The ACTIONS

trapezius has been ghosted in. O, Origin; I, insertion.
The sternocleidomastoid moves the neck and head at
the spinal joints.
Q Flexes the lower neck.
Q Extends the upper neck and head.
Q Laterally flexes the neck and head.
Q Contralaterally rotates the neck and head.
WHAT’S IN A NAME?
STABILIZATION
The name, sternocleidomastoid, tells us that this
muscle attaches to the sternum, clavicle, and mastoid Stabilizes the cervical spinal joints.
process of the temporal bone.
Derivation:
sterno: Gr. refers to the sternum INNERVATION
cleido: Gr. refers to the clavicle
mastoid: Gr. refers to the mastoid process Q Spinal accessory nerve (CN XI)
Q The SCM’s major superior attachment is the mastoid
process attachment of the temporal bone. However, it also
has a thin aponeurotic attachment to the occipital bone.
Q The carotid sinus of
the common carotid
artery lies directly
deep and medial to
the SCM, midway up
the neck. Because a Zzz...
neurologic reflex
occurs to lower blood
pressure when the
A carotid sinus is
pressed, massage
to this region must
be done judiciously,
especially with weak
8
or older clients.
Q The SCM and the scalenes are often injured as a result
of car accidents. This trauma is usually called whiplash
because the head and neck are forcefully thrown one way
and then the other,
similar to a whip being
lashed. When the head
and neck are thrown
posteriorly, the anterior
cervical musculature
B may be injured, causing
it to spasm. When the
FIGURE 8-33 Supine palpation of the right SCM as the client head and neck are
raises the head and neck from the table. A, Palpation of the thrown anteriorly, the
sternal head. B, Palpation of the clavicular head. same trauma may
occur to the posterior
musculature.
Q The SCM forms a border of the posterior triangle of the
PALPATION neck and is, therefore, an excellent landmark for palpating
1. The client is supine with the head and neck contra- other neck muscles. Locate the posterior (lateral) border of
the SCM, the anterior border of the upper trapezius, and the
laterally rotated. Place your palpating finger pads just
clavicle; and then palpate in the tall narrow triangular space
superior to the sternoclavicular joint. that is located between them.
2. Ask the client to lift the head and neck from the table.
Look for the SCM to become visible (Figure 8-33).
Note: The sternal head is usually more visible than the

clavicular head.
3. Strumming perpendicular to the fibers, palpate
superiorly toward the mastoid process attachment.
SPINE AND RIB CAGE: Scalene Group

Anterior Scalene; Middle Scalene; Posterior Scalene
Pronunciation AN 4%% RI OR3+!9 LEEN s -) DIL3+!9 LEEN s POS 4%% RI OR3+!9 LEEN
The scalene group is located in the antero-

lateral neck and is composed of three
muscles: the anterior, middle, and posterior
scalenes (Figure 8-34). The spinal and rib
O
attachments of the scalenes are deep to
other structures, but much of the middle
I bellies of the scalene muscles are superficial
in the posterior triangle of the neck
8 between the sternocleidomastoid (SCM)
and upper trapezius. The middle scalene
is the largest of the three; the posterior
A scalene is the smallest.
O
O
I
I
B C
FIGURE 8-34 A, Anterior view of the anterior scalene bilaterally. The other two scalenes have been
ghosted in on the left side. B, Anterior view of the middle scalene bilaterally. The other two scalenes
have been ghosted in on the left side. C, Anterior view of the posterior scalene bilaterally. The other
two scalenes have been ghosted in on the left side. O, Origin; I, insertion.

The name, scalene, tells us that these muscles have a Anterior Scalene and Middle Scalene
steplike or ladderlike shape.
The names anterior, posterior, and middle, tell us that Origin (Proximal Attachment)
the anterior scalene is the most anterior of the group; Q Transverse processes of the cervical spine
the posterior scalene is the most posterior of the group;
and the middle scalene is between the other two. Insertion (Distal Attachment)
Derivation: Q First rib
scalene: L. uneven, ladder
anterior: L. before, in front of
middle: L. middle (between)
posterior: L. behind, toward the back
Posterior Scalene
Q Transverse processes of the cervical spine

Q Second rib
ACTIONS
The scalenes move the neck at the spinal joints and
the ribs at the sternocostal and costospinal joints. All
FIGURE 8-35 Palpation of the right scalenes as the client takes
three scalenes laterally flex the neck and elevate the rib
in short, quick breaths through the nose.
to which they attach; the anterior and middle scalenes
also flex the neck.
the transverse process attachments. For the rib
8
Anterior Scalene and Middle Scalene attachments, with your finger pads oriented posteriorly,
Q Flex the neck. gently but firmly reach deep to the clavicle.
Q Laterally flex the neck.
Q Elevate the first rib. TREATMENT CONSIDERATIONS
Q The brachial plexus of nerves and the subclavian artery run
Posterior Scalene between the anterior and middle scalenes. If these muscles
Q Laterally flexes the neck. are tight, entrapment of these
nerves and/or the artery can
Q Elevates the second rib.
occur. When this happens,
it is called anterior scalene
STABILIZATION syndrome, one of the four
types of thoracic outlet
1. Stabilize the cervical spinal joints. syndrome. This condition
2. Stabilize the first and second ribs. can cause sensory
symptoms (e.g., tingling,
pain, numbness) and/or
INNERVATION motor symptoms (e.g.,
weakness, partial paralysis)
Q Cervical spinal nerves in the upper extremity.
Q Very close to the superior attachment of the anterior
scalene is the common carotid artery. Given the
PALPATION neurologic reflex that occurs to lower blood pressure
when the carotid sinus of the common carotid artery is
1. The client is supine. Locate the lateral border of pressed, massage to this region must be done judiciously,
the clavicular head of the SCM muscle (see Figure especially with weak or older clients.
8-33); then immediately drop off of it laterally onto the
Q The SCM and the
scalenes in the posterior triangle of the neck.
scalenes are often injured
2. With your finger pads pressing into the scalene as a result of car accidents.
muscle group, ask the client to take in short, quick This trauma is usually
breaths through the nose and feel for the contraction called whiplash because
of the scalene musculature (Figure 8-35). the head and neck are
forcefully thrown one way
3. Strumming perpendicular to the direction of the fibers, and then the other, like a
palpate as much of the scalenes in the posterior whip being lashed. When
triangle of the neck as possible. the head and neck are
thrown posteriorly, the
4. To palpate the origin (superior attachment) on the
anterior cervical
spine and the insertion (inferior attachment) on musculature may be
the ribs, slacken the SCM by passively laterally injured, causing it to spasm. When the head and neck
flexing the client’s neck to the same side. For the are thrown anteriorly, the same trauma may occur to the
spinal attachments, reach deep to the SCM toward posterior musculature.
SPINE AND RIB CAGE: Suprahyoid Muscles

Digastric; Stylohyoid; Mylohyoid; Geniohyoid
Pronunciation DI '!3 TRIK s 34) LO () OYD s -9 LO () OYD s *%% NEE O () OYD
The suprahyoids are named for attaching to and being located superior
to the hyoid bone. The four suprahyoid muscles are the digastric, stylo-
hyoid, mylohyoid, and geniohyoid (Figure 8-36). Other than a thin
fascial muscle called the platysma, the suprahyoid group is superficial.
Within this group, the geniohyoid is deep to the mylohyoid; and the
digastric has two bellies, an anterior belly and a posterior belly. In
addition, an infrahyoid group contains four muscles.
Anterior belly I
Posterior belly
O
Posterior belly
Central tendon I
A B Anterior belly
O
Stylohyoid
I
O
I
C D
FIGURE 8-36 A, Anterior view of the digastric bilaterally with other hyoid muscles ghosted in on the
client’s left side. B, Right lateral view of the digastric. C, Anterior view of the stylohyoid bilaterally with
the digastric ghosted in on the client’s left side. D, Right lateral view of the stylohyoid.
Mylohyoid
I 8
E F
Geniohyoid
O
I
G H
FIGURE 8-36, cont'd E, Anterior view of the mylohyoid bilaterally with the digastric shown on the
client’s left side. F, Right lateral view of the mylohyoid. G, Anterior view of the geniohyoid bilaterally
with the mylohyoid ghosted in on the client’s left side. H, Right lateral view of the geniohyoid.
WHAT’S IN A NAME?
The name, digastric, tells us that this muscle has two The name, geniohyoid, tells us that this muscle
bellies (gaster means belly). attaches to the hyoid bone. Genio, referring to the chin,
The name, stylohyoid, tells us that this muscle tells us that this muscle also attaches to the mandible.
attaches from the styloid process (of the temporal Derivation:
bone) to the hyoid bone. di: Gr. two
The name, mylohyoid, tells us that this muscle gastric: Gr. belly
attaches to the hyoid bone. Mylo, referring to the hyoid: Gr. refers to the hyoid bone
molar teeth, tells us that this muscle also attaches stylo: Gr. refers to the styloid process
close to the molar teeth. mylo: Gr. mill (refers to the molar teeth)
genio: Gr. chin
Turn page to 'more.

ATTACHMENTS
Digastric
Origin (Posterior Attachment)
Q Temporal bone
Insertion (Anterior Attachment)

Q Mandible
Note: The digastric has an intermediate central tendon

attached to the hyoid bone via a fascial sling of tissue.
Stylohyoid
8 Origin (Superior Attachment)
Q Styloid process of the temporal bone

Q Hyoid
Mylohyoid
Q Inner surface of the mandible
Insertion (Inferior Attachment) FIGURE 8-37 Palpation of the right suprahyoids.

Q Hyoid
Geniohyoid INNERVATION
Origin (Superior Attachment) Q Trigeminal nerve (cranial nerve [CN] V) and the facial
nerve (CN VII) (digastric)
Q Inner surface of the mandible
Q Facial nerve (CN VII) (stylohyoid)
Insertion (Inferior Attachment) Q Trigeminal nerve (CN V) (mylohyoid)
Q Hyoid Q Hypoglossal nerve (CN XII) (geniohyoid)
ACTIONS PALPATION
The suprahyoid group moves the mandible at the 1. The client is supine. Place your palpating finger pads
temporomandibular joints (TMJs), the head and neck just inferior to the mandible, just off center. Place your
at the spinal joints, and the hyoid bone. resistance hand under the client’s chin.
Q Elevates the hyoid bone (all four). 2. Ask the client to depress the mandible gently against
Q Depresses the mandible (all except the stylohyoid). resistance. Feel for the contraction of the suprahyoid
muscles (Figure 8-37).
Q Flexes the head and neck (all except the stylohyoid).
3. Continue palpating the suprahyoid muscles inferiorly
toward the hyoid bone while resisting mandibular
STABILIZATION
depression and strumming perpendicular to their
Stabilize the hyoid bone and TMJs. fibers.
4. To palpate the stylohyoid and the posterior belly of

the digastric, continue palpating laterally from the
hyoid toward the mastoid process of the temporal
bone, while resisting mandibular depression and
strumming perpendicular to the fibers (Figure 8-38).
Q The external carotid artery lies
inferior and deep to the
stylohyoid and posterior
belly of the digastric.
Massage to this region
must be judiciously done.
Q The digastric is the prime
mover of depression of the 8
mandible.
Q Tightness of the supra-
hyoid musculature can
cause or aggravate
TMJ dysfunction.
FIGURE 8-38 Palpation of the right stylohyoid and posterior belly

of digastric (of the suprahyoid group).
SPINE AND RIB CAGE: Infrahyoid Muscles

Sternohyoid; Sternothyroid; Thyrohyoid; Omohyoid
Pronunciation 34%2 NO () OYD s 34%2 NO 4() ROYD s 4() RO () OYD s / MO () OYD
The infrahyoids are named for attaching to and being located

inferior to the hyoid bone. The four infrahyoid muscles are the
sternohyoid, sternothyroid, thyrohyoid, and omohyoid (Figure
8-39). Other than the sternocleidomastoid and a thin fascial
muscle called the platysma, the infrahyoid group is superficial.
Within this group, the sternothyroid and thyrohyoid are deep to
the sternohyoid; and the omohyoid has two bellies, an inferior
belly and a superior belly. In addition, a suprahyoid group
8
contains four muscles.
Sternohyoid Sternothyroid I
O O
A B
FIGURE 8-39 A, Anterior view of the sternohyoid bilaterally. The omohyoid has been ghosted in on
the client's left side. B, Anterior view of the sternothyroid bilaterally. The thyrohyoid has been ghosted
in on the client's left side. Continued
Superior belly I
I
Thyrohyoid Central tendon
O
Inferior belly
8
O
C D
FIGURE 8-39, cont'd C, Anterior view of the thyrohyoid bilaterally. The sternothyroid has been ghosted in
on the client's left side. D, Anterior view of the omohyoid. The sternohyoid has been ghosted in on the
client's left side. O, Origin; I, insertion.
WHAT’S IN A NAME? Sternothyroid

The name, sternohyoid, tells us that this muscle Origin (Inferior Attachment)
attaches from the sternum to the hyoid bone. Q Sternum
The name, sternothyroid, tells us that this muscle
attaches from the sternum to the thyroid cartilage. Insertion (Superior Attachment)
The name, thyrohyoid, tells us that this muscle Q Thyroid cartilage
attaches from the thyroid cartilage to the hyoid bone.
The name, omohyoid, tells us that this muscle
attaches from the scapula (omo means shoulder, Thyrohyoid
referring to the scapula) to the hyoid bone.
Origin (Inferior Attachment)
Derivation: Q Thyroid cartilage
hyoid: Gr. refers to the hyoid
thyroid/thyro: Gr. refers to the thyroid cartilage Insertion (Superior Attachment)
sterno: L. refers to the sternum Q Hyoid
omo: Gr. shoulder
Omohyoid
ATTACHMENTS Origin (Inferior Attachment)
Q Scapula
Sternohyoid
Origin (Inferior Attachment) Insertion (Superior Attachment)
Q Sternum Q Hyoid
Insertion (Superior Attachment) Note: The omohyoid has an intermediate central tendon
attached to the clavicle via a fascial sling of tissue.
Q Hyoid
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ACTIONS
The infrahyoid group moves the head and neck at the
spinal joints and the hyoid bone.
Q Depresses the hyoid bone and thyroid cartilage.
Q Flexes the neck.
STABILIZATION
Stabilizes the hyoid bone and thyroid cartilage.
INNERVATION
Q Cervical plexus (sternohyoid, sternothyroid, omohyoid)
Q Hypoglossal nerve (CN XII) (thyrohyoid)
8
PALPATION
1. The client is supine. Place your palpating finger pads
immediately inferior to the hyoid, just off center. Place
your resistance hand under the client’s chin.
2. Ask the client to depress the mandible gently at the
TMJs against resistance. Feel for the contraction of
the infrahyoid muscles by strumming perpendicular to
their fibers (Figure 8-40).
3. Continue palpating them inferiorly toward the sternum
while resisting mandibular depression and strumming
perpendicular to their fibers. FIGURE 8-40 Palpation of the right infrahyoids.
Q The carotid sinus of the common carotid artery lies slightly Q The infrahyoids play
lateral to the infrahyoid musculature. Because a neurologic an important role in
reflex occurs to lower blood pressure when the carotid movement and
sinus is pressed, massage to this region must be judiciously stabilization of the
done, especially with weak or older clients. hyoid bone when
singing and playing
Q The infrahyoid muscles can indirectly assist stabilization of wind and brass
the TMJs by stabilizing the hyoid bone when the suprahyoid instruments.
muscles contract. With the hyoid stabilized, the suprahyoids
can exert their pull on the mandible, thereby stabilizing the Q The thyrohyoid can
TMJs. be considered to be
an upward continuation
Q The sternothyroid can play a role in stabilizing the hyoid of the sternothyroid
bone by stabilizing the thyroid cartilage when the thyrohyoid muscle.
contracts, which allows the contraction force of the
thyrohyoid to be exerted on the hyoid bone.
Notes
SPINE AND RIB CAGE: Prevertebral Group

Longus Colli; Longus Capitis; Rectus Capitis Anterior;
Rectus Capitis Lateralis
Pronunciation ,/.' US+/, EYE s ,/.' US+!0 I TIS s
2%+ TUS+!0 I TISAN 4%% RI OR s 2%+ TUS+!0 I TISLA TER ! LIS
The prevertebral group is composed of four muscles located deep in

the anterior neck. They are the longus colli, longus capitis, rectus capitis
anterior, and rectus capitis lateralis (Figure 8-41). The longus colli is
often described as having three parts: (1) superior oblique part, (2) inferior
oblique part, and (3) vertical part.
8
I
Superior
oblique part Longus capitis
Vertical part O
Inferior
oblique part
A B
FIGURE 8-41 A, Anterior view of the right longus colli. The longus capitis has been ghosted in on
the left. B, Anterior view of the right longus capitis. The longus colli has been ghosted in on the left. Continued
I I
O O
Rectus capitis anterior Rectus

capitis
lateralis
C D
8
FIGURE 8-41, cont'd C, Anterior view of the rectus capitis anterior bilaterally. The rectus capitis
lateralis has been ghosted in on the left. D, Anterior view of the rectus capitis lateralis bilaterally.
The rectus capitis anterior has been ghosted in on the left. O, Origin; I, insertion.
WHAT’S IN A NAME? Longus Capitis

The name, longus colli, tells us that this muscle is Origin (Inferior Attachment)
long and found in the neck. Q Transverse processes of the cervical spine (C3-C6)
The name, longus capitis, tells us that this muscle
is long and attaches to the head. Insertion (Superior Attachment)
The name, rectus capitis anterior, tells us that the Q Occiput
fibers of this muscle run straight and attach to the
head anteriorly (anterior to the rectus capitis lateralis). Rectus Capitis Anterior
The name, rectus capitis lateralis, tells us that the
fibers of this muscle run straight and attach to the Origin (Inferior Attachment)
head laterally (lateral to the rectus capitis anterior). Q Atlas (C1)
Derivation:
Insertion (Superior Attachment)
longus: L. long
colli: L. refers to the neck
Q Occiput
capitis: L. refers to the head
rectus: L. straight Rectus Capitis Lateralis
lateralis: L. refers to the side Origin (Inferior Attachment)
Q Atlas (C1)

ATTACHMENTS Q Occiput
Longus Colli
Origin (Inferior Attachment) ACTIONS
Q Anterior bodies and transverse processes of cervical
spine (C3-T3 vertebrae) The prevertebral muscles move the neck at the spinal
joints and the head at the atlanto-occipital joint.
Q Anterior arch (C1), anterior bodies and transverse Longus Colli
processes of cervical spine (C2-C6) Q Flexes the neck.
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FIGURE 8-42 Palpation of the right longus colli and capitis as

the client engages the muscles by lifting his head and neck into
8 flexion.
Longus Capitis
Q Flexes the neck and head.
Rectus Capitis Anterior

Q Flexes the head.
Rectus Capitis Lateralis

Q Laterally flexes the head.
STABILIZATION
Stabilizes the cervical spinal joints and the head.
FIGURE 8-43 Palpation of the right rectus capitis lateralis superior

to the transverse process of the atlas.
INNERVATION
Q Cervical spinal nerves
Note: If you feel a pulse under your fingers, you are
on the common carotid artery. Either gently move
it out of the way or move your fingers slightly to
PALPATION one side of it or the other, continuing to aim for the
The prevertebral muscles are palpated with the client longus musculature. If necessary, the client’s trachea
supine. can be gently displaced toward the other side of
the body to allow for easier access to the longus
Longus Colli and Capitis muscles. Being gentle with displacing the trachea
is important because many clients are sensitive to
1. Locate the medial border of the sternal head of the
having their trachea touched or moved.
sternocleidomastoid (SCM) muscle (see Fig. 8-33);
then immediately drop off of it medially onto the 3. To confirm that you are on the longus musculature,
longus muscles in the anterior neck. ask the client to flex the head and neck at the spinal
2. Gently and slowly but firmly sink in posteriorly and joints by lifting the head up from the table and feel for
slightly medially with your palpating finger pads their contraction (Figure 8-42).
toward the longus musculature (colli and capitis) 4. Once located, strum perpendicular to the fibers
on the anterior surface of the vertebral bodies and and palpate as far superiorly as possible and as far
transverse processes of the cervical spine. inferiorly as possible.
Rectus Capitis Lateralis TREATMENT CONSIDERATIONS

1. The rectus capitis lateralis is also quite deep but can Q The longus colli and longus capitis are often injured in a
sometimes be palpated and discerned from adjacent whiplash accident, wherein the head and neck are forcefully
tissue. Place palpating finger pads immediately thrown anteriorly and posteriorly (like a whip being lashed).
superior to the transverse process of the atlas (Figure Q The longus colli and longus capitis are also often aggravated
8-43). when doing a lot of sit-ups, crunches, or curl-ups.
Q The longus colli and other prevertebral muscles are important
Note: The location of the transverse process of the atlas for stabilizing the neck and head while
is immediately posterior to the ramus of the mandible and talking, swallowing, coughing, and
inferior to the ear. sneezing. They also stabilize the neck
during rapid arm movements. Talking,
2. Gently press into the small depression that can often swallowing, coughing, and sneezing
be felt here, and feel for the rectus capitis lateralis. can exacerbate deep anterior neck
pain in those who have a tight
Note: Because the location of the facial nerve and styloid or injured longus colli.
process is nearby, be careful to avoid pressing too forcefully. Q Clients with a tight longus
colli and/or longus capitis 8
Rectus Capitis Anterior often describe feeling as
though they have a sore
1. The rectus capitis anterior is extremely deep and is throat, especially when
usually not palpable. swallowing.
Q For many clients, the anterior neck can be an emotionally
sensitive area of the body. Before placing your palpating
hands there, let the client know that you will be working
there and obtain verbal consent. The anterior neck can
also be very physically sensitive because it has a number
of fragile structures; therefore palpation into this region
must be done carefully. When palpating, sink into the
tissue slowly and gently, but with pressure that is firm
enough to reach the longus musculature.
REVIEW QUESTIONS
1. What are the four muscles of the suboccipital 6. Which of the following muscles are involved in
group? respiration?
a. Rectus abdominis and obliquus capitis inferior
________________________________________________ b. Longus colli and digastric
c. Serratus posterior superior and serratus posterior
________________________________________________ inferior
d. Scalenes and splenius capitis
________________________________________________
7. What are the attachments of the quadratus
________________________________________________ lumborum?
a. Spinous processes of the lumbar spine to ribs
8 2. What are the three subgroups of the transverso- eight through ten
spinalis group? b. Iliac crest to the spinous processes of the lumbar
spine
________________________________________________ c. Transverse processes of the lumbar spine to the
scapula
________________________________________________ d. Iliac crest to the transverse processes of the
lumbar spine and the twelfth rib
________________________________________________
8. Which one of the following muscles is the deepest
3. What are the four suprahyoid muscles? muscle in the anterolateral abdominal wall?
a. External abdominal oblique
________________________________________________ b. Transversus abdominis
c. Internal abdominal oblique
________________________________________________ d. Rectus abdominis
________________________________________________ 9. The brachial plexus of nerves is located between

which of the following muscles?
________________________________________________ a. Anterior scalene and middle scalene
b. Splenius capitis and splenius cervicis
4. Which one of the following muscles flexes the c. Middle scalene and posterior scalene
trunk at the spinal joints? d. Erector spinae and transversospinalis
a. Erector spinae
b. External abdominal oblique 10. Which one of the following muscle groups attaches
c. Semispinalis from a transverse process inferiorly to a spinous
d. Digastric process superiorly?
a. Transversospinalis
5. Which of the following muscles attach onto the b. Erector spinae
mastoid process of the temporal bone? c. Scalenes
a. Sternocleidomastoid (SCM) and splenius capitis d. External intercostals
b. Rectus capitis posterior major and obliquus capitis
inferior
c. Anterior scalene and interspinales
d. Erector spinae and transversospinalis
CASE STUDY 1
A 52-year-old man is experiencing a bilateral mid-to-low QUESTIONS
back pain that extends to his upper gluteal region on both
sides. He is approximately 20 pounds overweight but 1. Which major muscles are likely involved?
otherwise appears to be in good health. He admits to little
______________________________________________________
regular physical activity in the last few years outside of
the occasional round of golf. The pain he is experiencing ______________________________________________________
started 1 week earlier after helping a friend load a moving
truck. He was sore and stiff for the following 2 to 3 days ______________________________________________________
and took an over-the-counter (OTC) pain medication. The
OTC medication reduced the sharp pain to a manageable 2. Why did flexion of the arms at the glenohumeral
dull pain, but the stiffness remained. The client says he joints cause low back pain?
re-experiences sharp pain if he attempts to lift anything
______________________________________________________
over 15 to 20 pounds. For example, when he removes a
full trash bag from the trash can, sharp pain develops in his ______________________________________________________
low back. 8
Postural analysis against a grid chart shows that the ______________________________________________________
client’s lumbar spine is hyperlordotic, and his thoracic
region is slightly hyperkyphotic. During active range-of- 3. Why would flexion of the thigh at the hip joint cause
motion (ROM) testing, the client is asked to stand with his pain in the lumbosacral region?
hands by his sides, feet shoulder-width apart, and flex the
trunk as far as possible. The client is only able to flex the ______________________________________________________
trunk 30 degrees before sharp pain develops, causing him ______________________________________________________
to flex his knees to regain balance. When asked to rotate
the trunk in each direction, stiffness and dull pain prevent ______________________________________________________
him from rotating beyond 20 degrees in each direction.
Flexion of each thigh at the hip joint causes pain in the 4. What would be recommended treatment options?
lumbosacral region, as does flexion of the arms at the
glenohumeral joints. On a pain scale of 0 to 10, his pain ______________________________________________________
reaches a threshold of 7 with these motions. The client ______________________________________________________
remarks that he now has more muscle tightness after
testing than before. ______________________________________________________
CASE STUDY 2
While taking the history of a new client, Susan, a 30-year- 4. When you hold your child, on what side of your body
old woman who had a baby 6 months earlier, recounts do you hold him or her?
that she had a difficult pregnancy with multiple back strain
______________________________________________________
issues that were treated with mild heat and massage.
She experienced intense middle-to-low back pain during ______________________________________________________
delivery, reaching a level of 8 on a pain scale of 0 to 10. ______________________________________________________
Immediately after delivery, she had difficulty moving,
bending over, and returning to a standing position. She said
that she felt like she had been hit in the back with a bat.
YOGA-RELATED QUESTIONS
Pain was sharp if she was not careful when moving. After
returning home from the hospital, Susan’s back strain issues 1. During yoga class, do any of the positions or asanas
were treated with heat, massage therapy, and stretching, all produce immediate pain or stiffness?
of which gradually helped, bringing her pain level down to
2 or 3. Susan returned to work 3 months after delivery. ______________________________________________________
8 A month ago, Susan started attending yoga classes twice ______________________________________________________
a week. The positions are difficult for her to attempt or hold
for any length of time. She is also experiencing temporary ______________________________________________________
stiffness and pain (reaching a level of 5 to 6), but she
assumes this pain and stiffness are part of learning yoga. In 2. Do you feel looser or tighter directly after yoga class?
the last week the soreness and stiffness have not subsided. ______________________________________________________
When she picks up her child, pain develops once again in
her low back. She returned to her physician and a magnetic ______________________________________________________
resonance image (MRI) was ordered; the results were ______________________________________________________
unremarkable. The physician suggested that she resume
massage therapy and heat treatments. Pain medication was 3. Do you experience increased pain and/or stiffness
offered, but Susan declined because she is breast-feeding. later in the day on the days that you attend yoga class
Postural analysis shows a slightly increased lumbar or upon awakening on the days after yoga class?
lordosis. Passive range-of-motion (ROM) testing produces
a feeling of stiffness and pain. Flexion of the trunk produces ______________________________________________________
dull pain in the lumbosacral region at a pain level of 4 on a ______________________________________________________
scale of 0 to 10. Extension of the trunk produces a sharp
______________________________________________________
pain at a level of 6. Left lateral flexion produces a pain level of
6 in the right low back, whereas right lateral flexion produces ______________________________________________________
pain at a 4 level in the left lower back. What questions from
the therapist would uncover additional information that might
help explain what is contributing to the pain? WORK-RELATED QUESTIONS
CHILD-RELATED QUESTIONS 1. Does your job require any form of lifting?
1. When you pick up your child, do you bend from the ______________________________________________________
back and reach over or do you bend at the knees? ______________________________________________________
______________________________________________________ ______________________________________________________
______________________________________________________ ______________________________________________________
______________________________________________________
2. Does your job require standing for any length of time?
2. When you remove your child from the crib, do you ______________________________________________________
lower the rail or reach over the rail?
______________________________________________________
______________________________________________________
______________________________________________________
______________________________________________________
______________________________________________________
______________________________________________________
3. What amount of stress is involved in your job?
3. When you use the stroller, do you bend from the
back or bend at the knees? ______________________________________________________
______________________________________________________ ______________________________________________________
______________________________________________________ ______________________________________________________
______________________________________________________ ______________________________________________________
CHAPTER
Muscles of the Head
9
CHAPTER OUTLINE
Overview of Function, 300 Muscles of Facial Expression—Nose, 318
Procerus
MUSCLES OF MASTICATION
Nasalis
Temporalis and Masseter, 304
Depressor Septi Nasi
Pterygoid Group, 306
Muscles of Facial Expression—Mouth, 322
Lateral Pterygoid
Levator Labii Superioris Alaeque Nasi
Medial Pterygoid
Levator Labii Superioris
MUSCLES OF THE SCALP Zygomaticus Minor
Muscles of the Scalp, 310 Zygomaticus Major
Occipitofrontalis Levator Anguli Oris
Temporoparietalis Risorius
Auricularis Anterior Buccinator
Auricularis Posterior Depressor Anguli Oris
Auricularis Superior Depressor Labii Inferioris
Mentalis
MUSCLES OF FACIAL EXPRESSION
Orbicularis Oris
Muscles of Facial Expression—Eye, 314
Platysma
Orbicularis Oculi
Levator Palpebrae Superioris
Corrugator Supercilii
T he muscles addressed in this chapter are the mus-

cles of the head. These muscles can be divided
into muscles of mastication (chewing), muscles of the
of facial expression can be further subdivided into
muscles of the eye, nose, and mouth. The contraction
of these muscles is important for displaying emotions.
scalp, and muscles of facial expression. Although some universality of facial expressions that
Mastication is the act of chewing. Therefore the display emotions are certainly apparent, variations are
muscles of mastication are those that attach to and are evident from one culture to another. Further, many of
involved in movement of the mandible at the temporo- these muscles may act in concert with others to add
mandibular joints (TMJs). The four major muscles of to the spectrum of facial expressions. Some sources
mastication are the temporalis, masseter, lateral ptery- state that more than 1800 separate facial expressions
goid, and medial pterygoid. can be created with combinations of the muscles of
facial expression.
Note: The eight muscles of the hyoid group are also
The companion CD at the back of this book allows
involved in mastication; they are discussed in Chapter 7.
you to examine the muscles of this body region, layer
Muscles of the scalp and facial expression are by layer, and individual muscle palpation technique
superficial fascial muscles. The muscles of the scalp videos are available in the Chapter 9 folder on the
are involved in moving the scalp and the ear. Muscles Evolve website.
299
OVERVIEW OF FUNCTION
The following general rules regarding actions can be Q If a muscle attaches to the mandible and its other
stated for the functional groups of muscles of mastica- attachment is posterior to the mandibular attach-
tion at the TMJs: ment, it can retract the mandible at the TMJs.
Q If a muscle attaches to the mandible and its other Q If a muscle attaches to the mandible and its other
attachment is superior to the mandibular attach- attachment is medial to the mandibular attach-
ment, it can elevate the mandible at the TMJs. ment, it can contralaterally deviate (do opposite
Q If a muscle attaches to the mandible and its other side deviation of) the mandible at the TMJs.
attachment is inferior to the mandibular attach- Q Reverse actions of the major muscles of mastication
ment, it can depress the mandible at the TMJs. are unlikely because they would require movement
Q If a muscle attaches to the mandible and its other of the entire head toward a fixed mandible (at the
attachment is anterior to the mandibular attach- TMJs).
ment, it can protract the mandible at the TMJs.
9
Superficial Right Lateral
View of the Muscles Temporalis (deep to fascia) Frontalis of occipitofrontalis
of the Head
Galea aponeurotica
Temporoparietalis
Orbicularis oculi
Procerus

alaeque nasi
Occipitalis
Nasalis
of occipitofrontalis 9
Levator labii
superioris
Zygomaticus minor
Auricularis muscles Zygomaticus major
Lateral pterygoid Levator anguli oris
Orbicularis oris
Masseter
Depressor labii
Buccinator inferioris
Mentalis
Depressor anguli oris

Risorius Platysma
FIGURE 9-1 Superficial right lateral view of the muscles of the head.
301
Anterior View of the
Muscles of the Head
Frontalis of occipitofrontalis Procerus Frontalis (cut)
Temporoparietalis Temporalis
Temporalis
OOc (cut)
Orbicularis oculi (OOc)

Levator palpebrae superioris
alaeque nasi (LLSAN)
LLSAN (cut)
Levator labii superioris (LLS)
9 Nasalis
Zygomaticus minor (ZMin)
LLS (cut)
Zygomaticus major (ZMaj)
ZMin (cut)
Levator anguli oris (LAO) ZMaj (cut)
Masseter
LAO (cut)
Buccinator
Depressor septi nasi
Risorius
Buccinator
Depressor anguli oris (DAO) Orbicularis oris
Depressor labii inferioris (DLI) DAO (cut)
Mentalis DLI (cut)
Platysma
FIGURE 9-2 Superficial anterior view of the muscles of the head. The platysma has been ghosted
in. Note: Acronyms used on the person’s left side are defined on the right side.
302
Posterior View of the
Muscles of the Head
Galea aponeurotica
Temporalis (deep to fascia) of occipitofrontalis
Auricularis superior Occipitalis
9
Auricularis posterior
FIGURE 9-3 Superficial posterior view of the muscles of the head.
303
MUSCLES OF THE HEAD

Temporalis; Masseter
Pronunciation TEM PO 2! LIS s -! SA TER
The temporalis and masseter are

O two of the four major muscles
of mastication (chewing). The
other two are the lateral and
Temporalis
medial pterygoids discussed in
the next layout. The temporalis
and masseter are superficial
muscles; the temporalis overlies
I the temporal bone and the
9 masseter overlies the mandible
(Figure 9-4). The masseter is
usually divided into two layers: a
superficial layer and a deep layer.
A
O
Deep
layer
Deep layer
Superficial Superficial layer

layer
I
B C
FIGURE 9-4 A, Lateral view of the right temporalis. B, Lateral view of the right masseter. The
temporalis has been ghosted in. C, Lateral view of the right masseter. The superficial layer of the
masseter has been ghosted in. O, Origin; I, insertion.

The name, temporalis, tells us that this muscle Temporalis
attaches onto the temporal bone.
The name, masseter, tells us that this muscle is Origin (Superior Attachment)
involved with chewing. Q Temporal fossa
Derivation:
temporalis: L. refers to the temple Insertion (Inferior Attachment)
masseter: Gr. chewer Q Coronoid process and the ramus of the mandible
Chapter 9 Muscles of the Head 305
Masseter
Q Inferior margins of both the zygomatic bone and the
zygomatic arch of the temporal bone

Q Angle, ramus, and coronoid process of the mandible
ACTIONS
Both the temporalis and masseter move the mandible FIGURE 9-5 Palpation of the right temporalis as the client
clenches the teeth.
at the temporomandibular joints (TMJs).
Q Elevate the mandible.
STABILIZATION
Stabilize the mandible at the TMJs.
9
INNERVATION
Q Trigeminal nerve (cranial nerve [CN] V)
PALPATION
Both the temporalis and masseter are palpated with
the client supine.
Temporalis
1. Place your palpating finger pads over the temporal
FIGURE 9-6 Palpation of the right masseter as the client
fossa on the head (superior to the ear). clenches the teeth.
2. Ask the client to alternately contract and relax the
temporalis; clenching the teeth and then relaxing the
jaw will accomplish this. Feel for the contraction of
the temporalis as the client clenches the teeth
(Figure 9-5). TREATMENT CONSIDERATIONS
3. Once the contraction of the temporalis has been felt,
Q The temporalis muscle is deep to thick fibrous fascia called
palpate the entire muscle as the client continues to
the temporalis fascia.
contract and relax it.
Q A tight temporalis and
masseter may be
Masseter involved with tension
1. Place your palpating finger pads between the headaches and with
dysfunction of the
zygomatic arch and the angle of the mandible.
temporomandibular
2. Ask the client to alternately contract and relax the joint (TMJ syndrome).
masseter; clenching the teeth and then relaxing the Q The temporal fossa is
jaw will accomplish this. Feel for the contraction of the much deeper in carnivores, allowing
masseter as the client clenches the teeth (Figure 9-6). for a much thicker and stronger
3. Once the contraction of the masseter has been felt, temporalis muscle, which contributes
palpate the entire muscle from the zygomatic arch to to the strength of a carnivore’s bite.
the angle of the mandible as the client continues to Q Proportional to its size, the masseter is stated by many
contract and relax it. sources to be the strongest muscle in the human body.
MUSCLES OF THE HEAD: Pterygoid Group

Lateral Pterygoid; Medial Pterygoid
Pronunciation ,!4 ER AL4%2 I GOYD s -%% DEE AL4%2 I GOYD
The pterygoid group is composed of the lateral pterygoid and medial

pterygoid muscles (Figure 9-7). The pterygoids are two of the four major
muscles of mastication (chewing). The temporalis and masseter are the
other two muscles and are discussed in the previous layout. Both ptery-
goids are deep to the mandible and best accessed from inside the mouth.
The lateral pterygoid has two heads: a superior head and an inferior head.
Superior head I
O
I O
Inferior head
A B
I I
C D
FIGURE 9-7 A, Lateral view of the right lateral pterygoid with the medial pterygoid ghosted in.
The mandible has been partially cut away. B, Posterior view of the right lateral pterygoid with the
medial pterygoid ghosted in. The cranial bones have been cut away. C, Lateral view of the right
medial pterygoid with the lateral pterygoid ghosted in. The mandible has been partially cut away.
D, Posterior view of the right medial pterygoid with the lateral pterygoid ghosted in. The cranial
bones have been cut away. O, Origin; I, insertion.
WHAT’S IN A NAME? PALPATION

The name, pterygoid, tells us that these muscles Both pterygoids are palpated with the client supine.
attach to the sphenoid bone (the pterygoid process).
The lateral pterygoid is lateral to the medial pterygoid. Lateral Pterygoid
Derivation: 1. Wearing either a glove or a finger cot, place your
pterygoid: Gr. wing shaped palpating finger inside the vestibule of the client’s
lateral: L. side mouth (between the cheeks and the teeth) and run
medial: L. toward the middle along the external surfaces of the upper teeth until
you reach the back molars. Then press posteriorly
and superiorly into a little pocket in the tissue
between the gum above the upper teeth and the
ATTACHMENTS condyle of the mandible. You will be on the internal
surface of the lateral pterygoid (Figure 9-8).
Lateral Pterygoid 2. Now ask the client to gently either protract the
mandible at the TMJs or deviate contralaterally
Origin (Anterior/Medial Attachment) the mandible slowly and carefully (deviate it to the
Q Sphenoid bone opposite side of the body). Feel for the contraction of
9
the lateral pterygoid (Figure 9-9).
Insertion (Posterior/Lateral Attachment)
Q Neck of the mandible and the TMJ capsule
Medial Pterygoid
Origin (Anterior/Medial/Superior Attachment)
Q Sphenoid bone
Insertion (Posterior/Lateral/Inferior Attachment)

Q Internal surface of the angle of the mandible
ACTIONS
The pterygoids move the mandible at the TMJs.
FIGURE 9-8 Supine palpation of the right lateral pterygoid shown
with a skull.
Lateral Pterygoid
Q Protracts the mandible.
Q Contralaterally deviates the mandible.
Medial Pterygoid
Q Elevates the mandible.
Q Protracts the mandible.
Q Contralaterally deviates the mandible.
STABILIZATION
Stabilizes the mandible at the TMJs.
INNERVATION FIGURE 9-9 Supine palpation of the right lateral pterygoid as the
client protracts the mandible.
Q Trigeminal nerve (cranial nerve [CN] V)
Turn page to 'more.

4. From outside the mouth: Curl your palpating fingers

around to the inside surface of the angle of the
mandible.
5. Ask the client to elevate the mandible at the TMJs
by clenching the teeth. Feel for the contraction of the
medial pterygoid (Figure 9-10).
Q The direction of fibers of the medial pterygoid is essentially
identical to the direction of the fibers of the masseter; in
fact, these two muscles occupy the same position. The
difference is that the masseter is external (superficial) to the
FIGURE 9-10 Palpation of the right medial pterygoid as the client
mandible, and the medial pterygoid is internal (deep) to the
clenches the teeth.
mandible.
Q A tight lateral or medial pterygoid may be involved with
dysfunction of the TMJ (TMJ syndrome).
3. Once felt, palpate as much of the lateral pterygoid
9 as possible, from the condyle of the mandible to the Q The lateral pterygoid functions to protract the mandible
inside wall of the mouth (above the gum of the upper and the articular disc of the TMJ. It is important that the
mandible and disc protract together when the jaw is
teeth).
opened. Therefore if the contraction of
the lateral pterygoid
is not precisely Help
Medial Pterygoid coordinated with !
1. From inside the mouth: Wearing either a glove or the other muscles
that move the
a finger cot, place your palpating finger along the
mandible, the
internal surfaces of the lower teeth until you reach articular disc may
the back molars, then press posterolaterally until you become jammed
reach the inside wall of the mouth. between the two
2. Now ask the client to protract the mandible. Feel for bones of the joint
and dysfunction
the contraction of the medial pterygoid.
of the TMJ (TMJ
3. Once felt, palpate as much of the medial pterygoid as syndrome) may
possible. occur.
Notes
MUSCLES OF THE HEAD: Muscles of the Scalp

Occipitofrontalis; Temporoparietalis;
Auricularis Anterior; Auricularis Posterior; Auricularis Superior
Pronunciation OK 3)0 I TO FRON 4! LIS s 4%- PO RO PA 2) I 4!, IS s
AW 2)+ U LA RISAN 4%% RI OR s AW 2)+ U LA RISPOS 4%% RI OR s AW 2)+ U LA RISSUE 0%% RI OR
The muscles of the scalp are the occipitofrontalis (consisting of

an occipitalis belly, a frontalis belly, and the intermediate galea
aponeurotica), the temporoparietalis, and the three muscles of
the auricularis group (auricularis anterior, auricularis posterior,
and auricularis superior) (Figure 9-11). The occipitofrontalis and
temporoparietalis are sometimes grouped together as the epicranius
muscle. The muscles of the scalp are superficial fascial muscles.
9
Galea aponeurotica
I
Frontalis
Occipitalis
A B
B
O
O
I O
I
O
C D
FIGURE 9-11 A, Lateral view of the right occipitofrontalis. The trapezius and sternocleidomastoid
have been ghosted in. B, Expression of elevating the eyebrows created by the bilateral contraction
of the occipitofrontalis. C, Lateral view of the right temporoparietalis. D, Lateral view of the right
auricularis muscles. O, Origin; I, insertion.
WHAT’S IN A NAME? Auricularis Group

The name, occipitofrontalis, tells us that this muscle Auricularis Anterior
lies over the occipital and frontal bones. Origin (Anterior Attachment)
The name, temporoparietalis, tells us that this
Q Galea aponeurotica
muscle lies over the temporal and parietal bones.
The name, auricularis, tells us that these muscles
are involved with the ear. Anterior, superior, and
Insertion (Posterior Attachment)
posterior tell us their locations relative to the ear. Q Anterior ear
Derivation: Auricularis Superior

occipitofrontalis: L. refers to the occiput and frontal
bone
temporoparietalis: L. refers to the temporal and
Q Galea aponeurotica
parietal bones
auricularis: L. ear Insertion (Inferior Attachment)
anterior: L. before, in front of Q Superior ear
superior: L. upper, higher than
Auricularis Posterior
posterior: L. behind, toward the back 9
Origin (Posterior Attachment)
Q Temporal bone

Q Posterior ear
ATTACHMENTS
Occipitofrontalis ACTIONS
Origin (Posterior Attachment) Occipitofrontalis
Q Occipital bone and temporal bone Q Draws the scalp posteriorly (elevation of the eyebrow).

Q Fascia and skin overlying the frontal bone Temporoparietalis
Q Elevates the ear.
Note: The galea aponeurotica, a fibrous fascial aponeurosis,
is intermediate between the occipital and frontal bellies of
the occipitofrontalis. Auricularis Group
Q Draws the ear anteriorly (auricularis anterior).
Temporoparietalis Q Elevates the ear (auricularis superior).

Q Draws the ear posteriorly (auricularis posterior).
Q Lateral border of the galea aponeurotica

INNERVATION
Q Fascia superior to the ear Q Facial nerve (cranial nerve [CN] VII)
Turn page to 'more.

A B
FIGURE 9-12 Palpation of the occipitofrontalis as the client engages it by raising the eyebrows.
A, Palpation of the right frontalis belly of the occipitofrontalis. B, Palpation of the right and left
occipitalis bellies of the occipitofrontalis muscles.
9
PALPATION
All three muscles and muscle groups are palpated with
the client supine.
Occipitofrontalis
1. Place your palpating finger pads on the forehead of
the client.
2. Ask the client to elevate the eyebrows. Feel for the
contraction of the frontalis belly (Figure 9-12, A); once
felt, palpate the entire frontalis.
3. Now palpate over the client’s occipital bone, and
ask the client to elevate the eyebrows. Feel for the
contraction of the occipitalis belly (Figure 9-12, B);
once felt, palpate the entire occipitalis.
Temporoparietalis
1. Place your palpating finger pads approximately 1 to
2 inches superior and slightly anterior to the ear.
2. Ask the client to elevate the ear. Feel for the muscle’s
contraction (Figure 9-13).
Auricularis group
1. Place your palpating finger pads either immediately
anterior, superior, or posterior to the ear, and ask the
client to move the ear in that direction, feeling for the
contraction of that particular auricularis muscle.
Note: Many people cannot consciously control muscles that

move their ears; therefore it is usually necessary to palpate
the temporoparietalis and auricularis muscles by location
FIGURE 9-13 Palpation of the right temporoparietalis.
while they are relaxed.
Q Because the occipitofrontalis can elevate the eyebrow, it Q Although the
can also be considered to be a muscle of facial expression. temporoparietalis
Elevation of the eyebrows is associated with the expressions and auricularis muscles
of surprise, shock, horror, fright, or recognition. It also often in humans are poorly
accompanies glancing upward. formed and often
nonfunctional, the
Q The occipitofrontalis
analogous muscles
is a muscle like any
mmmm... in dogs (and many
other in the body,
other animals) are
and moderate or
highly developed.
even deeper work
This is clear when
may be performed
one sees how a
to benefit the client.
dog can direct its
Because tension
ears toward the
headaches often
location from which a sound originates.
involve the occipito-
frontalis, this muscle
should be evaluated
in any client
complaining of 9
tension headaches.
MUSCLES OF THE HEAD:

Muscles of Facial Expression—Eye
Orbicularis Oculi; Levator Palpebrae Superioris; Corrugator Supercilii
Pronunciation OR ")+ YOU LA RIS/+ YOU LIE s ,% VAY TORPAL 0%% BREESU 0%% RI /2 IS s
+/2 U GAY TORSU PER 3), I EYE
The three muscles of facial expression of the eye are

the orbicularis oculi, levator palpebrae superioris, and
corrugator supercilii (Figure 9-14). The occipitofrontalis,
a muscle of the scalp presented in the last layout (see
page 310), can also be considered to be a muscle of facial
expression of the eye.
A B C
FIGURE 9-14 A, Anterior view of the right orbicularis oculi. B, Lateral view of the right levator
palpebrae superioris. C, Anterior view of the right corrugator supercilii.

The name, orbicularis oculi, tells us that this muscle Orbicularis Oculi
encircles the eye.
Q Encircles the eye (from the medial side of the eye, it
The name, levator palpebrae superioris, tells us
returns to the medial side of the eye)
that this muscle elevates the upper eyelid.
The name, corrugator supercilii, tells us that this
muscle wrinkles the skin of the eyebrow.
Levator Palpebrae Superioris
Derivation:
orbicularis: L. small circle
Q Sphenoid bone to the upper eyelid
oculi: L. refers to the eye
levator: L. lifter
palpebrae: L. eyelid
superioris: L. upper Q Inferior frontal bone to the fascia and skin deep to the
corrugator: L. to wrinkle together eyebrow
supercilii: L. refers to the eyebrow
ACTIONS Levator Palpebrae Superioris

Q Elevates the upper eyelid (Figure 9-16).
Orbicularis Oculi
Q Expressions: surprise, fear
Q Closes and squints the eye (Figure 9-15).
Q Expressions: wink, concern, perplexion
Q Draws the eyebrow inferomedially (Figure 9-17).
Q Expressions: anger, concern
INNERVATION
Q Facial nerve (cranial nerve [CN] VII) (orbicularis oculi
and corrugator supercilii)
Q Oculomotor nerve (cranial nerve [CN] III) (levator
palpebrae superioris)
9
PALPATION
Orbicularis Oculi
1. Gently place your palpating finger pad on the tissue
around the client’s eye, and ask the client to close the
eye somewhat forcefully. Feel for the contraction of
the orbicularis oculi (Figure 9-18).
FIGURE 9-15 Anterolateral view of the expression created by the 2. Once felt, palpate the entire muscle as the client
contraction of the right orbicularis oculi. alternately contracts and relaxes it.
FIGURE 9-16 Anterior view of the expression created by the FIGURE 9-17 Anterior view of the expression created by the
bilateral contraction of the levator palpebrae superioris. bilateral contraction of the corrugator supercilii.
Turn page to 'more.

Levator Palpebrae Superioris Corrugator Supercilii

1. Gently place your palpating finger pad on the client’s 1. Gently place your palpating finger pad on the medial
upper eyelid, and ask the client to elevate the portion of the client’s eyebrow, and ask the client
upper eyelid. Feel for the contraction of the levator to frown, bringing the eyebrows down. Feel for the
palpebrae superioris (Figure 9-19). contraction of the corrugator supercilii (Figure 9-20).
2. Once felt, palpate as much of the muscle as possible
Note: The corrugator supercilii can also be easily palpated
as the client alternately contracts and relaxes it.
by squeezing the medial eyebrow between palpating finger
pads while the client contracts it.
2. Once felt, palpate the entire muscle as the client
alternately contracts and relaxes it.
Q The palpebral part of the orbicularis oculi is under both
conscious and unconscious control and may contract
9 reflexly to close the eye (for protection and as part of
blinking).
Q If the orbicularis oculi contracts forcefully, wrinkles that
radiate out from the lateral eye will form; these wrinkles are
called crow’s feet.
Q When the tissue located superior to the eye is pulled down
around the eye by the contraction of the orbicularis oculi, it
helps shield the eye from bright sunlight.
Q When the corrugator supercilii contracts, it causes vertical
wrinkles superior and medial to the eyes.
FIGURE 9-18 Palpation of the right orbicularis oculi as the client

somewhat forcefully closes the eye as if to squint.
FIGURE 9-19 Palpation of the right levator palpebrae superioris FIGURE 9-20 Palpation of the right corrugator supercilii as the
in the upper eyelid as the client elevates the upper eyelid. client frowns.
Notes

Muscles of Facial Expression—Nose
Procerus; Nasalis; Depressor Septi Nasi
Pronunciation PRO 3!)2 RUS s NAY 3! LIS s DEE 02%3 OR3%0 TI.!9 ZI
Three muscles of facial expression of the nose are the

procerus, nasalis, and depressor septi nasi (Figure 9-21).
The levator labii superioris alaeque nasi presented in
the next layout (see page 322) is a muscle of facial
expression of both the mouth and the nose.
Transverse
part
Alar part
A B C
FIGURE 9-21 A, Anterior view of the right procerus. B, Anterior view of the right nasalis. C, Anterior
view of the right depressor septi nasi.

The name, procerus, tells us that this muscle helps Procerus
create the expression of superiority of a nobleman or
Q Fascia and skin medial to the eyebrow to the fascia
prince.
and skin over the nasal bone
The name, nasalis, tells us that this muscle is
involved with the nose.
The name, depressor septi nasi, tells us that this
muscle depresses the nasal septum. (The septum is
Nasalis
the midline cartilage of the nose.) Q Maxilla to the cartilage of the nose and the opposite-
Derivation: side nasalis muscle
procerus: L. chief noble, prince
nasalis: L. nose
depressor: L. depressor
septi: L. refers to the nasal septum Q Maxilla to the cartilage of the nose
nasi: L. refers to the nose
bilateral contraction of the procerus. bilateral contraction of the alar part of the nasalis.
ACTIONS
Procerus
Q Wrinkles the skin of the nose upward (Figure 9-22).
Q Draws down the medial eyebrow.
Q Expressions: superiority, disdain, frown
Nasalis
Q Flares the nostril (alar part) (Figure 9-23).
Q Constricts the nostril (transverse part) (Figure 9-24).
Q Expressions: challenge, excitement, anger

Q Constricts the nostril (see Figure 9-24).
Q Expressions: disdain, coolness
FIGURE 9-24 Anterior view of the expression created by the

INNERVATION bilateral contraction of the transverse part of the nasalis or the
depressor septi nasi.
Q Facial nerve (cranial nerve [CN] VII)
Turn page to 'more.

FIGURE 9-25 Palpation of the right procerus as the client makes FIGURE 9-26 Palpation of the right nasalis as the client flares her
a look of disdain. nostril.
PALPATION
Procerus 3. To palpate the transverse part, palpate more
1. Gently place your palpating finger pad(s) on the superiorly on the nose and ask the client to constrict
bridge of the client’s nose, and ask the client to make the nostril (as if pulling the middle of the nose down
a look of disdain, bringing the eyebrows down and/or toward the mouth).
wrinkling the skin of the nose upward. Feel for the 4. Once felt, palpate the entire transverse part of
contraction of the procerus (Figure 9-25). the muscle as the client alternately contracts and
2. Once felt, palpate the entire muscle as the client relaxes it.

Nasalis 1. Gently place your palpating finger pad directly inferior
1. Gently place your palpating finger pad on the infero- to the client’s nose, and ask the client to constrict
lateral aspect of the client’s nose, and ask the client the nostril (as if pulling the middle of the nose down
to flare the nostril (as when taking in a deep breath). toward the mouth). Feel for the contraction of the
Feel for the contraction of the alar part of the nasalis depressor septi nasi (Figure 9-27).
(Figure 9-26). 2. Once felt, palpate the entire muscle as the client
2. Once felt, palpate the entire alar part of the muscle as alternately contracts and relaxes it.
the client alternately contracts and relaxes it.
FIGURE 9-27 Palpation of the right depressor septi nasi as the

client constricts her nostril.
Q The action of wrinkling the skin of the nose and/or drawing
down the medial eyebrows can create the look of frowning or
disdain that a person may make to convey an air of superiority
(hence the name, procerus, meaning chief noble or prince).
Q Bringing the medial eyebrows down is part of the facial
expression of frowning, but it also helps shield the eyes from
bright sunlight.
Q The action of flaring the nostrils to increase the aperture for
breathing in is also important for deep inspiration.

Muscles of Facial Expression—Mouth
Levator Labii Superioris Alaeque Nasi;
Levator Labii Superioris; Zygomaticus Minor;
Zygomaticus Major; Levator Anguli Oris; Risorius; Buccinator;
Depressor Anguli Oris; Depressor Labii Inferioris;
Mentalis; Orbicularis Oris; Platysma
Pronunciation LE 6!9 TOR,!9 BE EYESOO 0%% RI O RISA ,%% KWE.!9 SI s
LE 6!9 TOR,!9 BE EYESOO 0%% RI / RIS s :) GO -!4 IK US-9 NOR s
:) GO -!4 IK US-!9 JOR s LE 6!9 TOR!.' YOU LIE/ RIS s RI 3/ RI US s "5+ SIN ! TOR s
DEE 02%3 OR!.' YOU LIE/ RIS s DEE 02%3 OR,!9 BE EYEIN &%% RI / RIS s
MEN 4! LIS s OR ")+ YOU ,! RIS/ RIS s PLA 4): MA
9 The twelve muscles of facial expression of the mouth are presented

here. They are the levator labii superioris alaeque nasi (LLSAN),
levator labii superioris, zygomaticus minor, zygomaticus major,
levator anguli oris, risorius, buccinator, depressor anguli oris,
depressor labii inferioris, mentalis, orbicularis oris, and platysma
(Figure 9-28). Of these muscles, the platysma is primarily located
in the neck but is classified as a muscle of facial expression
because of its action upon the lower face. The LLSAN is a muscle
of facial expression of the mouth and the nose; it has two parts, a
medial slip and a lateral slip.
Medial slip
Lateral slip
A B
FIGURE 9-28 A, Anterior view of the right levator labii superioris alaeque nasi (LLSAN). The levator
labii superioris and the orbicularis oris have been ghosted in. B, Anterior view of the right levator labii
superioris. The LLSAN and the orbicularis oris have been ghosted in.
C D
9
E F
FIGURE 9-28, cont'd C, Anterior view of the right zygomaticus minor. The zygomaticus major and the
orbicularis oris have been ghosted in. D, Anterior view of the right zygomaticus major. The zygo-
maticus minor and the orbicularis oris have been ghosted in. E, Anterior view of the right levator
anguli oris. The orbicularis oris has been ghosted in. F, Anterior view of the right risorius. The orbi-
cularis oris has been ghosted in. Continued
Turn page to 'more.

G H
9
I J
FIGURE 9-28, cont'd G, Right lateral view of the buccinator. The masseter has been ghosted in.
H, Anterior view of the right depressor anguli oris. The orbicularis oris has been ghosted in.
I, Anterior view of the right depressor labii inferioris. The orbicularis oris has been ghosted in.
J, Right lateral view of the mentalis.
K L
9
FIGURE 9-28, cont'd K, Anterior view of the orbicularis oris. L, Anterior view of the right platysma.
WHAT’S IN A NAME?
The name, levator labii superioris alaeque nasi, tells Derivation:
us that this muscle elevates the upper lip and is levator: L. lifter
involved with the ala (cartilage of the nostril of the labii: L. refers to the lip
nose). superioris: L. upper
The name, levator labii superioris, tells us that this alaeque: L. refers to the ala (alar cartilage)
muscle elevates the upper lip. nasi: L. refers to the nose
The name, zygomaticus minor, tells us that this zygomaticus: Gr. refers to the zygomatic bone
muscle attaches to the zygomatic bone and is smaller minor: L. smaller
than the zygomaticus major. major: L. larger
The name, zygomaticus major, tells us that this anguli: L. refers to the angle (of the mouth)
muscle attaches to the zygomatic bone and is larger oris: L. mouth
than the zygomaticus minor. risorius: L. laughing
The name, levator anguli oris, tells us that this buccinator: L. trumpeter, refers to the cheek
muscle elevates the angle of the mouth. depressor: L. depressor
The name, risorius, tells us that this muscle is inferioris: L. lower
involved with laughing. mentalis: L. chin
The name, buccinator, tells us that this muscle is orbicularis: L. small circle
found in the cheek region. platysma: Gr. broad, plate
The name, depressor anguli oris, tells us that this
muscle depresses the angle of the mouth.
The name, depressor labii inferioris, tells us that
this muscle depresses the lower lip.
The name, mentalis, tells us that this muscle is
related to the chin.
The name, orbicularis oris, tells us that this muscle
encircles the mouth.
The name, platysma, tells us that this muscle is
broad and flat in shape.
Turn page to 'more.

ATTACHMENTS
Levator Labii Superioris Alaeque Nasi Buccinator
Q Maxilla to the upper lip and nose Q Maxilla and mandible to the lips
Levator Labii Superioris Depressor Anguli Oris

Q Maxilla to the upper lip Q Mandible to the angle of the mouth
Zygomaticus Minor Depressor Labii Inferioris

Q Zygomatic bone to the upper lip Q Mandible to the lower lip
Zygomaticus Major Mentalis

Q Zygomatic bone to the angle of the mouth Q Mandible to the fascia and skin of the chin
Levator Anguli Oris Orbicularis Oris

Q Maxilla to the angle of the mouth Q Muscle that, in its entirety, surrounds the mouth
9 Risorius Platysma
Q Fascia and skin superficial to the masseter to the Q Subcutaneous fascia of the superior chest to the man-
angle of the mouth dible and the subcutaneous fascia of the lower face
ACTIONS
Levator Labii Superioris Alaeque Nasi Buccinator
Q Elevates the upper lip (Figure 9-29). Q Compresses the cheek against the teeth (Figure 9-35
Q Flares the nostril. on page 328).
Q Expressions: anger, smugness, contempt Q Expressions: pucker, exertion, sigh
Levator Labii Superioris Depressor Anguli Oris

Q Elevates the upper lip (Figure 9-30). Q Depresses the angle of the mouth (Figure 9-36 on
Q Expressions: disgust, smugness, contempt page 328).
Q Expressions: sadness, uncertainty, dislike
Zygomaticus Minor
Q Elevates the upper lip (Figure 9-31). Depressor Labii Inferioris
Q Expressions: smile, smugness Q Depresses the lower lip (Figure 9-37 on page 329).
Q Expressions: sorrow, doubt, irony
Zygomaticus Major
Q Elevates the angle of the mouth (Figure 9-32). Mentalis
Q Expressions: smile, laugh Q Elevates the lower lip (Figure 9-38 on page 329).
Q Everts and protracts the lower lip.
Levator Anguli Oris Q Expressions: doubt, pout, disdain
Q Elevates the angle of the mouth (Figure 9-33 on page
328). Orbicularis Oris
Q Expressions: smile, sneer (“Dracula” expression) Q Closes the mouth (Figure 9-39 on page 329).
Q Protracts the lips.
Risorius Q Expressions: puckering, whistling
Q Draws laterally the angle of the mouth (Figure 9-34 on
page 328). Platysma
Q Expressions: grin, smile, laugh Q Draws up the skin of the superior chest and neck,
creating ridges of skin of the neck (Figure 9-40 on
page 329).
Q Expressions: disgust, disdain (“Creature from the
Black Lagoon” expression)
bilateral contraction of the LLSAN. bilateral contraction of the zygomaticus minor.
bilateral contraction of the levator labii superioris. bilateral contraction of the zygomaticus major.
Turn page to 'more.

contraction of the right levator anguli oris. bilateral contraction of the buccinator.
bilateral contraction of the risorius. bilateral contraction of the depressor anguli oris.
bilateral contraction of the depressor labii inferioris. contraction of the orbicularis oris.
bilateral contraction of the mentalis. bilateral contraction of the platysma.
Turn page to 'more.

INNERVATION Levator Labii Superioris

Q Facial nerve (cranial nerve [CN] VII) 1. Gently place your palpating finger pad approxi-
mately 1⁄2 inch lateral to the center of the upper lip
at its superior margin, and ask the client to elevate
the upper lip to show you the upper gum. Feel for
PALPATION the contraction of the levator labii superioris (Figure
9-42).
Note: The orbicularis oris has been ghosted in Figures 9-41 2. Once felt, palpate the entire muscle toward the eye as
through 9-49. the client alternately contracts and relaxes it.
Levator Labii Superioris Alaeque Nasi Zygomaticus Minor

1. Gently place your palpating finger pad just lateral to 1. Gently place your palpating finger pad approximately
the client’s nose, and ask the client to either elevate 1⁄ to 3⁄ inch lateral to the center of the upper lip at
2 4
the upper lip to show you the upper gum or flare the its superior margin, and ask the client to elevate the
nostril. Feel for the contraction of the levator labii upper lip to show you the upper gum. Feel for the
superioris alaeque nasi (Figure 9-41). contraction of the zygomaticus minor (Figure 9-43).
9 2. Once felt, palpate the entire muscle as the client 2. Once felt, palpate the entire muscle toward the
alternately contracts and relaxes it. zygomatic bone as the client alternately contracts and
relaxes it.
FIGURE 9-41 Palpation of the right levator labii superioris alaeque FIGURE 9-42 Palpation of the right levator labii superioris as the
nasi as the client elevates the upper lip and flares the nostril. client elevates her upper lip.
Zygomaticus Major
1. Gently place your palpating finger pad immediately
superolateral to the angle (corner) of the mouth,
and ask the client to smile by drawing the corner of
the mouth both superiorly and laterally. Feel for the
contraction of the zygomaticus major (Figure 9-44).
2. Once felt, palpate the entire muscle toward the
zygomatic bone as the client alternately contracts and
relaxes it.
Levator Anguli Oris

superior to the corner of the mouth, and ask the
client to elevate the corner of the mouth directly
superiorly as if to show you the canine tooth
(making what could be described as a Dracula-like
expression). Feel for the contraction of the levator 9
anguli oris (Figure 9-45).
FIGURE 9-44 Palpation of the right zygomaticus major as the

client smiles. The zygomaticus minor has been ghosted in.
FIGURE 9-43 Palpation of the right zygomaticus minor as the FIGURE 9-45 Palpation of the right levator anguli oris as the
client elevates her upper lip. The zygomaticus major has been client elevates the corner of the mouth (making a Dracula-like
ghosted in. expression).
Turn page to 'more.

PALPATION—cont'd
Risorius
lateral to the corner of the mouth, and ask the client
to draw the corner of the mouth directly laterally. Feel
for the contraction of the risorius (Figure 9-46).
Buccinator
1. Gently place your palpating finger pad lateral and
slightly superior to the corner of the mouth, and ask
the client to take in a deep breath, purse the lips, and
press the lips against the teeth as if expelling air while
playing the trumpet. Feel for the contraction of the
buccinator (Figure 9-47).
9
Depressor Anguli Oris

1. Gently place your palpating finger pad slightly lateral
and inferior to the corner of the mouth, and ask the
client to frown by depressing and drawing the corner
of the mouth laterally. Feel for the contraction of the FIGURE 9-46 Palpation of the right risorius as the client draws
depressor anguli oris (Figure 9-48). the corner of the mouth laterally.

Depressor Labii Inferioris

1. Gently place your palpating finger pad inferior to the
lower lip and slightly lateral to the midline, and ask
the client to depress and slightly draw the lower lip
laterally. Feel for the contraction of the depressor labii
inferioris (Figure 9-49).
Mentalis
1. Gently place your palpating finger pad approximately
1 inch inferior to the lower lip and slightly lateral to the
midline, and ask the client to depress and stick out
the lower lip as if pouting. Feel for the contraction of
the mentalis (Figure 9-50).
Orbicularis Oris
1. Wearing a finger cot or glove, gently place your
palpating finger pad(s) on the tissue of the lips, and
ask the client to pucker up the lips. Feel for the
contraction of the orbicularis oris (Figure 9-51).
FIGURE 9-47 Palpation of the right buccinator as the client takes
2. Once felt, palpate the entire muscle as the client in a deep breath, purses the lips, and presses the lips against
alternately contracts and relaxes it. the teeth as if playing the trumpet.
FIGURE 9-48 Palpation of the right depressor anguli oris as the FIGURE 9-49 Palpation of the right depressor labii inferioris
client frowns. The orbicularis oris has been ghosted in. as the client depresses and draws the lower lip laterally. The
orbicularis oris has been ghosted in.
FIGURE 9-50 Palpation of the right mentalis as the client sticks FIGURE 9-51 Palpation of the orbicularis oris on the right side as
out the lower lip as if pouting. the client puckers the lips.
Turn page to 'more.

PALPATION—cont'd TREATMENT CONSIDERATIONS

Q Long-standing contraction of a facial expression muscle
Platysma creates wrinkles in the skin of the face that run perpendicu-
1. Place your palpating finger pads on the anterolateral lar to the direction of fibers of the underlying muscle. Botox
neck, and ask the client to contract the platysma injections remove these wrinkles because Botox paralyzes
forcefully by depressing and drawing the lower lip facial expression musculature. However, this paralysis also
laterally, while keeping the mandible fixed in a position decreases the person’s ability to create facial expressions to
convey emotion.
of slight depression. Observe and feel for the ridges
of skin of the neck caused by the contraction of the Q The levator anguli oris is also known as the caninus. This
platysma (Figure 9-52). name is given because the contraction of the levator anguli
oris can result in the teeth, especially the canine tooth,
2. Once felt, palpate the entire muscle as the client becoming visible. Bilateral contraction of this muscle can
alternately contracts and relaxes it. reproduce the typical Dracula expression wherein the canine
teeth are exposed.
Q The action of compressing the cheeks against the teeth
by the two buccinators working bilaterally is important for
forcefully expelling air from the mouth. The buccinator is
the muscle that contracts when a musician blows air into
9 a brass or woodwind instrument, whistles, or blows up a
balloon.
Q The actions of the mentalis of elevating, everting, and
protracting the lower lip are also useful when drinking.
Q The orbicularis oris in humans is particularly well developed.
This is necessary for the intricacies of speech.
Q The contraction of the orbicularis oris causes the lips to
close and protrude as in puckering the lips for a kiss or
whistling.
Q The platysma in humans is considered to be a remnant of
a broader fascial muscle called the panniculus carnosus
found in four-legged mammals. The panniculus carnosus is
what enables a horse to shake off flies from its skin, and it is
the same muscle that enables a cat to raise the hair on its
back.
Q When the platysma contracts and the ridges or wrinkling
of the skin of the neck occurs, it is reminiscent of the
FIGURE 9-52 Anterior view of the right platysma contracted and title character from the film The Creature from the Black
being palpated. Lagoon.
REVIEW QUESTIONS
1. Name two of the major muscles of mastication. 6. Which of the following muscles encircles the
mouth?
________________________________________________ a. Orbicularis oculi
b. Zygomaticus minor
________________________________________________ c. Depressor anguli oris
d. Orbicularis oris
2. Name two muscles of facial expression of the nose.
7. Which of the following muscles flares the nostril?
________________________________________________ a. Depressor septi nasi
b. Nasalis
________________________________________________ c. Levator labii superioris
d. Platysma
3. Name three muscles of facial expression of the eye.
8. Which of the following muscles is located within
9
________________________________________________ the subcutaneous fascia of the superior chest?
a. Platysma
________________________________________________ b. Auricularis posterior
c. Occipitofrontalis
________________________________________________ d. Masseter
4. Which of the following muscles can elevate the 9. Which of the following muscles is a muscle of
mandible at the TMJs? fascial expression of the mouth?
a. Temporalis, masseter a. Procerus
b. Medial pterygoid, lateral pterygoid b. Zygomaticus minor
c. Temporalis, occipitofrontalis c. Corrugator supercilii
d. Lateral pterygoid, temporoparietalis d. Nasalis
5. Which of the following muscles draws the scalp 10. Which of the following muscles attaches into the
posteriorly? capsule of the TMJ?
a. Temporoparietalis a. Lateral pterygoid
b. Auricularis superior b. Medial pterygoid
c. Occipitofrontalis c. Masseter
d. Temporalis d. Temporalis
CASE STUDY 1
A 52-year-old male client, Robert, has recently been having QUESTIONS
pain and fatigue when chewing hard and/or crunchy foods
such as steak, pretzels, and popcorn. Mild pain develops in 1. Why has holding ropes in his mouth created pain for
his jaw and cheek as he chews. On a pain scale of 0 to 10, Robert?
the pain intensity is approximately a 3 or 4. He experiences
______________________________________________________
no pain when he is not chewing. Verbal history reveals no
pathologic history or injury to the face or jaw structure. ______________________________________________________
However, he recently visited his dentist for his biannual
cleaning. The dentist told him that he showed minimal signs ______________________________________________________
of teeth grinding and that an x-ray examination showed
______________________________________________________
minor temporomandibular joint (TMJ) osteoarthritis; however,
both are mild and not unusual for someone his age. Robert ______________________________________________________
states that he does not think he clenches or grinds his teeth
at night because his wife has never heard him do this. When ______________________________________________________
asked about stress levels, Robert admits that his work has
become more stressful lately, but he has taken up sailing 2. What treatment plan would most benefit Robert?
9 to help alleviate the stress. Further questioning reveals that
______________________________________________________
when sailing, Robert uses his mouth to hold the ropes as he
pulls the sails. ______________________________________________________
Physical examination elicits tenderness and a pain
intensity of approximately 4 when palpating between the ______________________________________________________
zygomatic arch and the angle of the mandible, and a level
______________________________________________________
3 when palpating over the temporal fossa of the head.
Palpating directly over the TMJ reveals a pain intensity of ______________________________________________________
approximately 3.
______________________________________________________
______________________________________________________
______________________________________________________
CASE STUDY 2
A new client, Dolores, comes to see you for chronic QUESTIONS
headaches. She is a 42-year-old account executive, who
admits to having a very stressful job and a long history 1. Should you palpate and assess any other
of a tight neck and tension headaches. She has always musculature? If so, what?
received neck massage for her headaches, and it has
______________________________________________________
always been successful—until now. The headache she is
experiencing now began 6 days ago. It feels similar to all ______________________________________________________
her previous headaches but has not been relieved with
two neck massages received this week. She believes that ______________________________________________________
the therapist she has gone to for years is very competent
______________________________________________________
but has been unable to help her this time. Concerned, she
visited her medical physician earlier today, who found no ______________________________________________________
reason for her headaches; she was told to take an over-
the-counter analgesic medication and return in 1 week ______________________________________________________
if the headaches do not subside. She has come to you ______________________________________________________
because she has heard that you work more thoroughly and
clinically than many other massage therapists.
2. If you find this musculature to be tight and a
9
Your verbal history reveals that her current headache is
possible cause of Dolores’ headaches, how should
indeed quite similar to and fits the pain pattern of all her
you proceed with treatment?
previous headaches. She states that her massage therapist
has always worked the posterior neck, with special ______________________________________________________
attention to muscles that the therapist said were the upper
trapezius and semispinalis capitis. ______________________________________________________
Upon physical examination, you palpate and discern
______________________________________________________
that the upper trapezius and semispinalis capitis are only
mildly tight. You palpate the entire posterior, lateral, and ______________________________________________________
anterior cervical region and find no musculature that seems
tight enough to justify Dolores’ long-standing headaches. ______________________________________________________
Dolores reports that with her usual headaches, when the ______________________________________________________
therapist would press into the back of her neck, she would
feel the headache pain refer into her head. However, with ______________________________________________________
the present headache, when the therapist worked her neck
______________________________________________________
and now when you are palpating into her neck, Dolores
does not feel the pain refer into her head. ______________________________________________________
CHAPTER
Muscles of the Pelvis and Thigh
10
CHAPTER OUTLINE
Overview of Function: Muscles of the Hip Joint, 339 Iliopsoas, 360

Overview of Function: Muscles of the Spinal Iliacus
Joints, 340 Psoas Major
Overview of Function: Muscles of the Knee Joint, 340 Psoas Minor, 364
Adductor Group, 366
MUSCLES OF THE PELVIS
Adductor Longus
Gluteal Group, 346
Adductor Brevis
Gluteus Maximus
Adductor Magnus
Gluteus Medius
Pectineus
Gluteus Minimus
Gracilis
Deep Lateral Rotator Group, 350
Quadriceps Femoris Group, 372
Piriformis
Rectus Femoris
Superior Gemellus
Vastus Lateralis
Obturator Internus
Vastus Medialis
Inferior Gemellus
Vastus Intermedius
Obturator Externus
Articularis Genus, 376
Quadratus Femoris
Hamstring Group, 378
MUSCLES OF THE THIGH Biceps Femoris
Tensor Fasciae Latae, 356 Semitendinosus
Sartorius, 358 Semimembranosus
T he muscles of this chapter are involved with motions

of the thigh or pelvis at the hip joint and/or motions
of the leg or thigh at the knee joint. The psoas major also
on the leg. These muscles move the leg relative to the
thigh or the thigh relative to the leg.
crosses the lumbar vertebral joints and can therefore you to examine Chapter 10 muscles, layer by layer, and
move the spine. The bellies of the gluteal and deep lat- individual muscle palpation technique videos are avail-
eral rotator groups and the iliacus are located on the pel- able in the Chapter 10 folder on the Evolve website.
vis. The bellies of the psoas major and minor are located
in the abdomen. The bellies of the adductor, quadriceps
femoris, and hamstring groups, as well as the tensor fas- OVERVIEW OF FUNCTION: MUSCLES
ciae latae and sartorius, are located in the thigh. OF THE HIP JOINT
As a general rule, muscles that move the hip joint
have their origin (proximal attachment) on the pelvis The following general rules regarding actions can be
and their insertion (distal attachment) on the thigh (or stated for the functional groups of muscles of the hip
leg). These muscles move the thigh relative to the pel- joint:
vis or the pelvis relative to the thigh. Muscles that move Q If a muscle crosses the hip joint anteriorly with a ver-
the knee joint have their origin (proximal attachment) on tical direction to its fibers, it can flex the thigh at the
the pelvis or thigh and their insertion (distal attachment) hip joint (standard action) by moving the anterior
339
surface of the thigh toward the anterior surface of Q If a muscle crosses the spinal joints posteriorly with
the pelvis; or it can anteriorly tilt the pelvis at the hip a vertical direction to its fibers, it can extend the
joint (reverse action) by moving the anterior surface trunk, neck, and/or head at the spinal joints by
of the pelvis toward the anterior surface of the thigh. moving the superior attachment down toward the
Q If a muscle crosses the hip joint posteriorly with inferior attachment in back.
a vertical direction to its fibers, it can extend the Q If a muscle crosses the spinal joints laterally, it
thigh at the hip joint (standard action) by moving can perform same-side lateral flexion of the trunk,
the posterior surface of the thigh toward the pos- neck, and/or head at the spinal joints by moving
terior surface of the pelvis; or it can posteriorly tilt the superior attachment down toward the inferior
the pelvis at the hip joint (reverse action) by mov- attachment on that side of the body.
ing the posterior surface of the pelvis toward the Q Reverse actions occur by moving the pelvic or lower
posterior surface of the thigh. spine attachment (origin) toward the upper spine
Q If a muscle crosses the hip joint laterally with a ver- attachment (insertion). This movement usually
tical direction to its fibers, it can abduct the thigh at occurs when a person is lying down.
the hip joint (standard action) by moving the lat-
eral surface of the thigh toward the lateral surface
of the pelvis; or it can depress (laterally tilt) the
same-side pelvis at the hip joint (reverse action) by OF THE KNEE JOINT
moving the lateral surface of the pelvis toward the The following general rules regarding actions can be
lateral surface of the thigh. stated for the functional groups of muscles of the knee
10 Q If a muscle crosses the hip joint medially, it can joint:
adduct the thigh at the hip joint by moving the Q If a muscle crosses the knee joint anteriorly with a
medial surface of the thigh toward the medial sur- vertical direction to its fibers, it can extend the leg
face of the pelvis (standard action); or it can elevate at the knee joint by moving the anterior surface of
the same-side pelvis at the hip joint (reverse action) the leg toward the anterior surface of the thigh.
by moving the medial surface of the pelvis toward Q If a muscle crosses the knee joint posteriorly with
the medial surface of the thigh. a vertical direction to its fibers, it can flex the leg
Q Medial rotators of the thigh at the hip joint (standard at the knee joint by moving the posterior surface
action) wrap around the femur from medial to lat- of the leg toward the posterior surface of the thigh.
eral, anterior to the hip joint. They can also ipsilater- Q If a muscle wraps around the knee joint, it can rotate
ally rotate the pelvis at the hip joint (reverse action). the knee joint (the knee joint can only rotate if it
Q Lateral rotators of the thigh at the hip joint (standard is first flexed). Medial rotators attach to the medial
action) wrap around the femur from medial to lateral, side of the leg. The biceps femoris is the only lateral
posterior to the hip joint. They can also contralater- rotator and attaches to the lateral side of the leg.
ally rotate the pelvis at the hip joint (reverse action). Q Reverse actions are common at the knee joint and
Q Reverse actions are common at the hip joint and tend to occur when the foot is planted on the
tend to occur when the foot is planted on the ground, causing the distal attachment to be fixed
ground, which causes the distal attachment to be and therefore the proximal attachment (the thigh)
fixed and therefore the proximal attachment to be to be mobile and move toward the distal attach-
mobile and move toward the distal attachment. ment (the leg).
The reverse actions wherein the pelvis moves at Q The reverse action of extension of the leg at the knee
the hip joint are often as important as, if not more joint is extension of the thigh at the knee joint in
important than, the typically thought of standard which the anterior surface of the thigh moves toward
mover actions of the thigh at the hip joint. the anterior surface of the leg.
Note: This movement occurs every time we stand up from a
OVERVIEW OF FUNCTION: MUSCLES seated position.
OF THE SPINAL JOINTS
Q The reverse action of flexion of the leg at the knee
The following general rules regarding actions can be joint is flexion of the thigh at the knee joint in
stated for the functional groups of muscles of the spi- which the posterior surface of the thigh moves
nal joints: toward the posterior surface of the leg.
Q If a muscle crosses the spinal joints anteriorly with Q The reverse action of medial rotation of the leg at
a vertical direction to its fibers, it can flex the trunk, the knee joint is lateral rotation of the thigh at the
neck, and/or head at the spinal joints by moving knee joint; the reverse action of lateral rotation of
the superior attachment (insertion) down toward the leg at the knee joint is medial rotation of the
the inferior attachment (origin) in front. thigh at the knee joint.
Anterior Views of the Muscles
of the Hip Joint—Superficial
12th rib
Psoas minor
Psoas major
Iliacus
Inferior vena cava
Piriformis
Abdominal aorta
Inguinal ligament
Gluteus medius
Gluteus medius
Tensor fasciae latae Gluteus minimus
Sartorius Piriformis 10
Iliopsoas distal
belly/tendon
Femoral nerve, artery,
and vein
Greater trochanter
of femur
Pectineus
Iliotibial band (ITB)

Adductor longus
Gracilis
Adductor magnus
Vastus lateralis
Quadriceps Rectus femoris
femoris Vastus medialis
Patella
Head of fibula
Tibial tuberosity
Pes Sartorius
anserine Gracilis
tendon
A Semitendinosus
FIGURE 10-1 Anterior views of the muscles of the hip joint. A, Superficial view on the right and
an intermediate view on the left. Continued
341
Anterior Views of the Muscles
of the Hip Joint—
Deep Views
T12
12th rib
L1
Psoas minor
Iliac crest
Psoas major
Piriformis
Anterior superior
iliac spine (ASIS)
Iliacus
Inguinal ligament
Gluteus medius
10
Gluteus minimus
Piriformis
Greater trochanter Iliopsoas distal

of femur belly/tendon
Pectineus
Pectineus
Adductor longus
Obturator externus
Adductor brevis
Gracilis
Adductor magnus Adductor magnus
Gracilis
Patella
Head of fibula
Tibial tuberosity
B
FIGURE 10-1, cont'd Anterior views of the muscles of the hip joint. B, Deep view on the right
and deeper view on the left.
342
Posterior Views of the Muscles
of the Hip Joint—Superficial
Iliac crest
Gluteus medius
Gluteus medius Sacrotuberous ligament

(deep to fascia)
Piriformis
Tensor fasciae Superior gemellus

latae
Obturator internus
Inferior gemellus
Gluteus maximus Sciatic nerve
Greater trochanter
of femur
10
Quadratus femoris
Iliotibial band
(ITB) Ischial tuberosity
Vastus lateralis Adductor magnus
Vastus lateralis
Adductor magnus
Gracilis
Long head
Biceps femoris
Short head
Semitendinosus
Biceps femoris
Popliteal artery and vein
Plantaris
Tibial nerve
Semimembranosus
Common fibular nerve
Sartorius
FIGURE 10-2 Posterior views of the muscles of the hip joint. A, Superficial view on the left and
an intermediate view on the right. Continued
343
Posterior Views of the Muscles
of the Hip Joint—
Deep Views
Iliac crest Psoas major
Gluteus medius (cut)
Gluteus minimus Posterior superior

iliac spine (PSIS)
Piriformis
Gluteus minimus
Superior gemellus Sciatic nerve
Obturator internus
Obturator
Inferior gemellus externus
Obturator externus
Intertrochanteric
Femoral artery
crest
10 Quadratus femoris Iliopsoas
(cut) distal tendon
Lesser trochanter
Ischial tuberosity
Adductor magnus
Anterior
Vastus lateralis head Adductor
magnus
Posterior
head
Vastus lateralis
Gracilis
Biceps femoris Popliteal artery

short head and vein
Semimembranosus Sciatic nerve
Tibial nerve
Plantaris
Sartorius
FIGURE 10-2, cont'd Posterior views of the muscles of the hip joint. B, Deep view on the left
and deeper view on the right.
344
Medial and Lateral Views of the Muscles
of the Right Hip Joint—Superficial Views
Iliacus L5
Sacrum
Anterior
superior iliac Anterior sacroiliac ligaments
spine (ASIS)
Piriformis
Obturator internus
Psoas major Coccygeus
Gluteus maximus
Psoas minor
Coccyx
Anoccygeal ligament
Pubic
symphysis
Levator ani
Adductor Ischial tuberosity

longus Iliac crest
10
Adductor magnus
Rectus femoris
Semimembranosus Anterior superior
iliac spine
Semitendinosus (ASIS)
Vastus medialis
Sartorius
Sartorius Tensor fasciae

Gluteus medius latae
(deep to fascia)
Rectus femoris
Gracilis
Patella Iliotibial band

Gluteus maximus (ITB)
Pes anserine tendon
A Vastus lateralis
Long head
Biceps femoris
Short head
Semimembranosus
Patella
Head of fibula
FIGURE 10-3 A, Medial view of the muscles of the right hip joint—superficial. B, Lateral view of
the muscles of the right hip joint—superficial.
345
MUSCLES OF THE PELVIS AND THIGH: Gluteal Group

Gluteus Maximus; Gluteus Medius; Gluteus Minimus
Pronunciation ',// TEE US-!8 I MUS s
',// TEE US-%%$ EE US s ',// TEE US-). I MUS
The gluteal group is composed of

three muscles, the gluteus maximus,
gluteus medius, and gluteus
minimus. The gluteus maximus is
the largest muscle in the human
body and forms the contour of the
O
buttock. It is superficial and covers
much of the gluteus medius. The
Gluteus gluteus medius is deep to the gluteus
maximus
maximus posteriorly and deep to
10 the tensor fasciae latae anteriorly,
but it is superficial laterally. It covers
I most all of the gluteus minimus. The
gluteus minimus is the deepest and
smallest of the group (Figure 10-4).
A
O
O
Gluteus
minimus
Gluteus
medius
I I
B C
FIGURE 10-4 A, Posterior view of the right gluteus maximus. The tensor fasciae latae, fascia over
the gluteus medius, and iliotibial band have been ghosted in. B, Lateral view of the right gluteus
medius. The piriformis has been ghosted in. C, Lateral view of the right gluteus minimus. The
piriformis has been ghosted in. O, Origin; I, insertion.
Chapter 10 Muscles of the Pelvis and Thigh 347
WHAT’S IN A NAME? Gluteus Maximus

The name, gluteus maximus, tells us that this muscle
Q Extends the thigh.
is located in the gluteal (buttock) region and is larger Q Laterally rotates the thigh.
than the gluteus medius and gluteus minimus. Q Abducts the thigh (upper fibers only).
The name, gluteus medius, tells us that this Q Adducts the thigh (lower fibers only).
muscle is located in the gluteal region and is smaller
than the gluteus maximus and larger than the gluteus
Q Posteriorly tilts the pelvis.
minimus. Q Contralaterally rotates the pelvis.
The name, gluteus minimus, tells us that this
muscle is located in the gluteal region and is smaller
than the gluteus maximus and gluteus medius. Gluteus Medius and Minimus
Derivation:
Q Abduct the thigh.
gluteus: Gr. buttocks Q Extend the thigh (posterior fibers only).
maximus: L. greatest Q Flex the thigh (anterior fibers only).
medius: L. middle Q Laterally rotate the thigh (posterior fibers only).
minimus: L. least
Q Medially rotate the thigh (anterior fibers only).
Q Depress the same-side pelvis.
Q Posteriorly tilt the pelvis. 10
ATTACHMENTS Q Anteriorly tilt the pelvis.
Q Contralaterally rotate the pelvis.
Gluteus Maximus
Origin (Proximal Attachment) STABILIZATION
Q Posterior iliac crest, posterolateral sacrum, and Stabilizes the thigh and pelvis at the hip joint.
coccyx

Q Iliotibial band (ITB) and the gluteal tuberosity of the
INNERVATION
femur Q Inferior gluteal nerve (gluteus maximus)
Q Superior gluteal nerve (gluteus medius and minimus)
Gluteus Medius and Minimus
Q External ilium
PALPATION
Gluteus Maximus
1. The client is prone. Place your palpating finger pads
Q Greater trochanter of the femur
lateral to the sacrum. Place your resistance hand on
the distal posterior thigh (if resistance is needed).
2. Ask the client to laterally rotate the thigh at the hip
ACTIONS joint and then extend the laterally rotated thigh. Feel
for the contraction of the gluteus maximus (Figure
All of the actions listed for the gluteal muscles occur
10-5). Resistance can be added, if necessary.
at the hip joint. The standard actions (insertion/distal
attachment moving toward origin/proximal attach- 3. With the muscle contracted, strum perpendicular to
ment) move the thigh at the hip joint; the reverse the fibers to discern the borders of the muscle.
actions (origin/proximal attachment moving toward 4. Continue palpating the gluteus maximus laterally and
insertion/distal attachment) move the pelvis at the inferiorly (distally) to its insertion (distal attachments)
hip joint. by strumming perpendicular to its fibers.
Turn page to 'more.

Gluteus Medius and Minimus for the contraction of the middle fibers of the gluteus
1. The client is side lying. Place your palpating finger medius (Figure 10-6, A). If desired, resistance can
pads just distal to the middle of the iliac crest, be added to the client’s thigh abduction with the
between the iliac crest and the greater trochanter of resistance hand.
the femur. Place your resistance hand on the lateral 3. Strum perpendicular to the fibers, palpating the
surface of the distal thigh (if resistance is needed). middle fibers of the gluteus medius distally toward the
2. Palpating just distal to the middle of the iliac crest, greater trochanter.
ask the client to abduct the thigh at the hip joint. Feel 4. To palpate the anterior fibers, place your palpating
hand immediately distal and posterior to the anterior
superior iliac spine (ASIS), and ask the client to gently
flex and medially rotate the thigh at the hip joint. Feel
for the contraction of the anterior fibers of the gluteus
medius (Figure 10-6, B). Discerning the anterior fibers
from the more superficial tensor fasciae latae is difficult.
5. To palpate the posterior fibers, place your palpating
hand over the posterior portion of the gluteus medius,
and ask the client to gently extend and laterally rotate
the thigh at the hip joint. Feel for the contraction of
the posterior fibers of the gluteus medius (Figure
10 10-6, C). Discerning the posterior fibers from the
more superficial gluteus maximus is difficult.
6. Palpating and discerning the gluteus minimus deep
to the gluteus medius is difficult. The gluteus minimus
FIGURE 10-5 Palpation of the right gluteus maximus as the client is thickest anteriorly. To palpate the gluteus minimus,
extends and laterally rotates the thigh at the hip joint against follow the same procedure as for the gluteus medius,
resistance.
and try to palpate deeper for the gluteus minimus.
FIGURE 10-6 Side-lying palpation of the right gluteus medius.

A, Palpation of the middle fibers of the right gluteus medius
immediately distal to the middle of the iliac crest as the client
attempts to abduct the thigh at the hip joint against resistance.
B, Palpation of the anterior fibers of the gluteus medius as the
client abducts and medially rotates the thigh. C, Palpation of the
posterior fibers of the gluteus medius as the client abducts and
laterally rotates the thigh.
A
B C
Q Thinking of the gluteus Q When one foot is lifted off the floor, the pelvis should fall
maximus as the speed to that side because it is now unsupported. However, the
skater’s muscle can be gluteus medius and minimus on the support-limb (opposite)
helpful. The gluteus side, which contract and create a force of same-side
maximus is powerful in depression of the pelvis, prevent the pelvis from falling to
extending, abducting, that side. Therefore the pelvis remains level. With every step
and laterally rotating the thigh a person takes, contraction of the gluteus medius on the
at the hip joint, which are all support side occurs. You can easily feel this when walking
actions that are necessary or even walking in place.
when speed skating.
Q The gluteus medius and minimus contract to create a force
Q Usually a thick layer of fascia, of same-side pelvic depression when weight is simply
called the gluteal fascia or shifted to one foot. Therefore the habitual practice of
the gluteal aponeurosis, standing with all or most of the body weight on one side
overlies the gluteus medius muscle. tends to cause the gluteus medius and minimus on that
Q Lateral rotation of the thigh at the hip joint by the gluteal side to become overused and tight.
muscles acts to prevent medial rotation of the thigh and Q The gluteus medius can be thought of as the “deltoid of the
entire lower extremity, including the talus at the subtalar joint.
hip joint” because it performs all the same actions to the
This lateral rotation can stabilize the subtalar joint and prevent
thigh at the hip joint as the deltoid does to the arm at the
excessive pronation (dropping of the arch) of the foot.
glenohumeral joint.
Q When the gluteus medius 10
is tight, it pulls on and
depresses the pelvis to-
ward the thigh on that side.
This results in a functional
short leg (as opposed to a
structural short leg wherein
the femur and/or the tibia on
one side is actually shorter
than on the other side).
Further, depressing the pelvis
on one side creates an
unlevel sacrum for the spine
to sit on, and a compensatory
scoliosis must occur to return the head to a level position.
MUSCLES OF THE PELVIS AND THIGH:

Deep Lateral Rotator Group
Piriformis; Superior Gemellus; Obturator Internus;
Inferior Gemellus; Obturator Externus; Quadratus Femoris
Pronunciation PI RI &/2 MIS s SU 0%% REE ORJEE -%, US s OB TOO 2!9 TORIN 4%2 NUS s
IN &%% REE ORJEE -%, US s OB TOO 2!9 TOREX 4%2 NUS s KWOD 2!4% US&%- O RIS
The deep lateral rotator group is composed of six muscles that are
located in the posterior pelvis, deep to the gluteus maximus. They
are, from superior to inferior, the piriformis, which lies directly next
to the gluteus medius, the superior gemellus, obturator internus,
inferior gemellus, obturator externus, and quadratus femoris (Figure
10-7). The obturator externus is the only muscle of the deep lateral
rotator group that is not visible in the second layer of the posterior
pelvic muscles. It is either entirely covered or nearly entirely covered
10 by the quadratus femoris. The quadratus femoris is a fairly massive
muscle; it is often larger than the piriformis.
All muscles of this group laterally rotate the thigh at the hip
joint when the pelvis is fixed and contralaterally rotate the pelvis
at the hip joint when the thigh is fixed.
Piriformis Superior
gemellus
O
O
I I
A B
FIGURE 10-7 Posterior views of the deep lateral rotator group muscles. A, The piriformis has
been drawn on both sides. The gluteus medius has been ghosted in on the left. B, The superior
gemellus is shown on both sides. The piriformis has been ghosted in on the left.
Obturator Inferior
internus gemellus
O I I
O
C D
Obturator Quadratus 10
externus femoris
O
I I
O
E F
FIGURE 10-7, cont'd Posterior views of the deep lateral rotator group muscles. C, The obturator
internus is shown on both sides. The superior gemellus and inferior gemellus have been ghosted
in on the left. D, The inferior gemellus is shown on both sides. The quadratus femoris has been
ghosted in on the left. E, The obturator externus is shown on both sides. The quadratus femoris has
been cut and ghosted in on the left. F, The quadratus femoris is shown on both sides. The adductor
magnus has been ghosted in on the left. O, Origin; I, insertion.
WHAT’S IN A NAME?
The name, piriformis, tells us that this muscle is The name, quadratus femoris, tells us that this
shaped like a pear. muscle is square in shape and attaches to the femur.
The name, superior gemellus, tells us that this Derivation:
muscle is the more superior muscle of a pair of similar piriformis: L. pear shaped
muscles. gemellus: L. twin
The name, inferior gemellus, tells us that this obturator: L. to stop up, obstruct (refers to the
muscle is the more inferior muscle of a pair of similar obturator foramen)
muscles. superior: L. upper
The name, obturator internus, tells us that this inferior: L. lower
muscle attaches to the internal surface of the internus: L. inner
obturator foramen. externus: L. outer
The name, obturator externus, tells us that this quadratus: L. squared
muscle attaches to the external surface of the femoris: L. refers to the femur
obturator foramen.
Turn page to 'more.

ATTACHMENTS ACTIONS
Piriformis The standard actions (insertion/distal attachment
moving toward origin/proximal attachment) move the
Origin (Proximal Attachment) thigh at the hip joint.
Q Anterior sacrum The reverse actions (origin/proximal attachment
moving toward insertion/distal attachment) move the
Insertion (Distal Attachment) pelvis at the hip joint.
Piriformis
Superior Gemellus Q Laterally rotates the thigh.
Q Horizontally extends the thigh.
Q Medially rotates the thigh (if the thigh is first abducted
Q Ischial spine
to approximately 60 degrees or more).
Q Contralaterally rotates the pelvis.
Superior Gemellus, Obturator Internus,
10 Obturator Internus Inferior Gemellus, Obturator Externus,
Quadratus Femoris
Q Laterally rotate the thigh.
Q Internal surface of the pelvic bone surrounding the
obturator foramen
Q Contralaterally rotate the pelvis.
Insertion (Distal Attachment) STABILIZATION

1. All muscles of the deep lateral rotator group stabilize
the thigh and pelvis at the hip joint.
Inferior Gemellus 2. The piriformis also stabilizes the sacrum at the
sacroiliac and lumbosacral joints
Q Ischial tuberosity

INNERVATION
Piriformis
Q Nerve to piriformis (of the lumbosacral plexus)
Obturator Externus
Origin (Proximal Attachment) Superior Gemellus, Obturator Internus
Q External surface of the pelvic bone surrounding the Q Nerve to obturator internus (of the lumbosacral
obturator foramen plexus)

Q Trochanteric fossa of the femur Inferior Gemellus, Quadratus Femoris
Q Nerve to quadratus femoris (of the lumbosacral
plexus)
Quadratus Femoris
Obturator Externus
Q Obturator nerve
Q Intertrochanteric crest of the femur
PALPATION
1. The client is prone with the leg flexed to 90 degrees
at the knee joint. Place your palpating finger pads
just lateral to the sacrum, halfway between the
posterior superior iliac spine (PSIS) and the apex of
the sacrum. Place the support/resistance hand on the
medial surface of the distal leg, just proximal to the
ankle joint.
2. Gently resist the client from laterally rotating the thigh
at the hip joint, and feel for the contraction of the
piriformis (Figure 10-8).
Note: Lateral rotation of the client’s thigh involves the client’s
foot moving medially toward the midline (and opposite side) FIGURE 10-8 Palpation of the right piriformis as the client
of the body. attempts to laterally rotate the thigh at the hip joint against
gentle-to-moderate resistance.
3. Continue palpating the piriformis laterally toward the
superior border of the greater trochanter of the femur
by strumming perpendicular to the fibers as the client
alternately contracts (against resistance) and relaxes
10
the piriformis.
4. To palpate the quadratus femoris, place your
palpating finger pads just lateral to the lateral border
of the ischial tuberosity, and place your support/
resistance hand on the medial surface of the distal
leg, just proximal to the ankle joint. Follow the same
procedure as for the piriformis, and feel for the
contraction of the quadratus femoris (Figure 10-9).
5. Continue palpating the quadratus femoris laterally
toward the intertrochanteric crest by strumming
perpendicular to the fibers as the client alternately
contracts (against resistance) and relaxes the
quadratus femoris. FIGURE 10-9 Palpation of the right quadratus femoris as the
client attempts to laterally rotate the thigh at the hip joint against
6. To palpate the other deep lateral rotators, either find
gentle-to-moderate resistance.
the piriformis and palpate inferior to it, or find the
quadratus femoris and palpate superior to it. Follow
the same procedure used to palpate the piriformis
and quadratus femoris by giving gentle resistance to
the client’s lateral rotation of the thigh at the hip joint
(Figure 10-10).
Note: Discerning these muscles from each other is difficult.
FIGURE 10-10 Palpation of the other deep lateral rotators by

first locating the piriformis and then dropping inferiorly off it. This
palpation is performed as the client attempts to laterally rotate
the thigh against gentle-to-moderate resistance.
Turn page to 'more.

Q Probably the most common method to stretch the piriformis middle of it. Some sources believe
is to have the client supine with the foot flat on the table this condition makes the
(i.e., the thigh flexed at the hip joint and the leg flexed at the sciatic nerve more susceptible
knee joint); then horizontally flex (horizontally adduct) the to being compressed if the
client’s thigh toward the opposite side of the body. piriformis is tight; others do
Q The piriformis can change from being a lateral rotator of the not. When the piriformis
thigh at the hip joint to a medial rotator of the thigh at the compresses the sciatic
hip joint (if the thigh is first flexed at the hip joint); therefore nerve, regardless of the
the method of stretching the piriformis varies with the relationship between the
position of the client’s thigh. If the client’s thigh is flexed, piriformis and the sciatic
lateral rotation must be used to stretch the piriformis. If nerve, this condition
the client’s thigh were not flexed, medial rotation would be is called piriformis
used. The thigh must be flexed to at least 60 degrees for syndrome and can result
the piriformis to become a medial rotator of the thigh. in symptoms of sciatica.
Q The piriformis often protectively tightens when the client’s Q A force of lateral rotation of the thigh prevents medial
sacroiliac joint is sprained. rotation of the thigh and entire lower extremity (including the
talus at the subtalar joint), if the foot overly pronates (and if
Q The sciatic nerve normally exits from the pelvis between the
the arch of the foot collapses).
piriformis and the superior gemellus. However, in approxi-
mately 10% to 20% of individuals, part or all of the sciatic Q Be careful with pressure on the quadratus femoris
nerve may pierce the piriformis muscle, exiting through the because the sciatic nerve passes over this muscle.
10
Notes
MUSCLES OF THE PELVIS AND THIGH

Tensor Fasciae Latae (TFL)
Pronunciation 4%. SOR&!3( EE A,! TEE
ATTACHMENTS
The tensor fasciae latae (TFL) is superficial
and located anterolaterally on the Origin (Proximal Attachment)
proximal thigh (Figure 10-11). Q Anterior superior iliac spine (ASIS)

Q ITB
O
ACTIONS
TFL The TFL moves the thigh and pelvis at the hip joint.
Q Flexes the thigh.
I Q Abducts the thigh.
10
Q Medially rotates the thigh.
Q Anteriorly tilts the pelvis.
Q Depresses the same-side pelvis.
STABILIZATION
ITB
Q Stabilizes the thigh and pelvis at the hip joint.
Q Stabilizes the knee joint via its attachment into the
ITB.
INNERVATION
Q Superior gluteal nerve
FIGURE 10-11 Lateral view of the right tensor fasciae latae (TFL). PALPATION
The gluteus maximus has been ghosted in. ITB, Iliotibial band.
1. The client is supine with the thighs on the table and
O, origin; I, insertion.
legs hanging off the table.
Note: If this position is uncomfortable for the client, the foot
of the lower extremity not being palpated can be placed on
WHAT’S IN A NAME? the table to stabilize the pelvis and low back.
The name, tensor fasciae latae, tells us that this mus-
2. Place your palpating finger pads just distal and lateral
cle tenses the fascia lata. The fascia lata is the broad
to the ASIS. Place the resistance hand on the distal
covering of fascia that envelops the musculature of
anterolateral thigh.
the thigh (the iliotibial band [ITB] is a thickening of the
fascia lata). 3. Ask the client to medially rotate and flex the thigh
Derivation: at the hip joint. Feel for the contraction of the TFL.
tensor: L. stretcher Resistance can be given with the resistance hand
fasciae: L. band/bandage (Figure 10-12).
latae: L. broad, refers to the side 4. Continue palpating the TFL distally to its ITB
attachment by strumming perpendicular to the fibers.
Q If the TFL is tight, it can
increase tension in the
ITB, thereby increasing
the likelihood of ITB
friction syndrome at the
greater trochanter or lateral
condyle of the femur.
Q Given that both the TFL
and the gluteus maximus
attach into the ITB and
the ITB crosses the knee
joint anteriorly, both of
these muscles help stabilize
FIGURE 10-12 The right TFL is palpated by asking the client to
the knee joint and perhaps contribute to extension of the
medially rotate and flex the thigh at the hip joint.
knee joint as well.
10

Sartorius
Pronunciation SAR 4/2 EE US
The sartorius is the longest muscle in the ATTACHMENTS

body and is superficial for its entire course Origin (Proximal Attachment)
from the pelvis to the tibia. It crosses the Q Anterior superior iliac spine (ASIS)
hip joint anteriorly, crosses the knee joint
posteriorly, and then returns anterior Insertion (Distal Attachment)
to attach to the proximal anterior tibia Q Pes anserine tendon at the proximal anteromedial
tibia
(Figure 10-13).
ACTIONS
O The sartorius moves the thigh and pelvis at the hip
joint and the leg at the knee joint.
10 Q Flexes the thigh.
Q Abducts the thigh.
Q Laterally rotates the thigh.
Q Anteriorly tilts the pelvis.
Sartorius
Q Flexes the leg.
STABILIZATION
1. Stabilizes the thigh and pelvis at the hip joint.
2. Stabilizes the knee joint.
INNERVATION
I Q Femoral nerve
FIGURE 10-13 Anterior view of the right sartorius. The tensor

PALPATION
fasciae latae and iliotibial band have been ghosted in. O, Origin; 1. The client is supine with the thighs on the table and
I, insertion.
legs hanging off the table.
Note: If this position is uncomfortable for the client, the foot
WHAT’S IN A NAME? the table to stabilize the pelvis and low back.
The name, sartorius, tells us that this muscle
2. Place your palpating finger pads just distal and medial
performs the four actions necessary to create a
to the ASIS. Place the resistance hand on the distal
cross-legged position that a sartor (Latin for tailor) sits
anteromedial thigh.
in to do his or her work. These actions are flexion,
abduction, and lateral rotation of the thigh at the hip 3. Ask the client to laterally rotate and flex the thigh at
joint and flexion of the leg at the knee joint. the hip joint. Feel for the contraction of the sartorius
Derivation: (Figure 10-14).
sartorius: L. tailor 4. Continue palpating the sartorius toward its distal
attachment by strumming perpendicular to the fibers.
Q The sartorius is one of
three muscles that
attach into the pes
anserine tendon.
Pes anserine means
goose foot. The
other two muscles
that attach here are
the gracilis and the
semitendinosus.
Q The medial border of
the sartorius is the lateral
border of the femoral triangle
of the thigh. The femoral triangle is located between the
FIGURE 10-14 The proximal belly of the right sartorius engages medial borders of the sartorius and adductor longus and
and is easily palpable when the client laterally rotates and flexes contains the femoral nerve, artery, and vein.
the thigh at the hip joint. Note: The therapist usually palpates Q The lateral femoral cutaneous nerve sometimes pierces
from the same side of the table but is shown here standing on
the sartorius, which can lead to entrapment of this nerve,
the opposite side of the table for the purpose of this photograph.
causing a condition known as meralgia paresthetica.
10
MUSCLES OF THE PELVIS AND THIGH: Iliopsoas

Iliacus; Psoas Major
Pronunciation ) LEE O 3/ AS s I LEE !+ USs3/ AS-!9 JOR
The iliopsoas is composed of two muscles: the iliacus

and psoas major. These two muscles have distinct
origins (proximal attachments), but their distal
bellies blend, and they have a common insertion
(distal attachment) on the femur. The psoas major’s
belly lies deep in the posterior abdominal wall
against the lumbar spine. The iliacus lies deep against
the anterior (internal) surface of the pelvic bone.
However, their distal belly is superficial immediately
distal to the inguinal ligament (Figure 10-15).
10
O Psoas major Psoas major
Iliacus O Iliacus
I
I
A B
FIGURE 10-15 A, Anterior view of the psoas major bilaterally. The left iliacus has been drawn in, and
the rectus abdominis has been ghosted in. B, Anterior view of the iliacus bilaterally. The left psoas
major has been drawn in, and the rectus abdominis has been ghosted in. O, Origin; I, insertion.

1. Both the iliacus and psoas major stabilize the thigh
The name, iliacus, tells us that this muscle attaches
and pelvis at the hip joint.
onto the ilium.
The name, psoas major, tells us that this muscle is 2. The psoas major also stabilizes the lumbar spinal
located in the loin (low back) area and is larger than joints.
the psoas minor.
Derivation:
iliacus: L. refers to the ilium INNERVATION
psoas: Gr. loin (low back)
Q Femoral nerve (iliacus)
major: L. larger
Q Lumbar plexus (psoas major)
Iliacus 1. The client is seated with the trunk slightly flexed.
Place your palpating finger pads anterolaterally on
Origin (Proximal Attachment) the client’s abdominal wall, approximately halfway
Q Internal ilium between the umbilicus and the anterior superior iliac
spine (ASIS); ensure placement is lateral to the lateral 10
Insertion (Distal Attachment) border of the rectus abdominis.
Q Lesser trochanter of the femur 2. Place the finger pads of your other hand over the
fingers of your palpating hand to increase the strength
and stability of the palpating fingers (Figure 10-16, A).
Psoas Major 3. Ask the client to take in a deep but relaxed breath.
Origin (Proximal Attachment) As the client exhales, slowly (but firmly) sink in toward
Q Anterolateral lumbar spine the belly of the psoas major by pressing diagonally
in toward the spine. You may need to repeat this
Insertion (Distal Attachment) procedure two to three times before arriving at the
psoas major.
Q Lesser trochanter of the femur
4. To confirm that you are on the psoas major, ask the
client to gently flex the thigh at the hip joint by lifting
the foot slightly off the floor. Feel for the contraction
ACTIONS of the psoas major.
Both the iliacus and psoas major move the thigh and 5. Strum perpendicularly across the fibers to feel for the
pelvis at the hip joint. The psoas major also moves the width of the muscle. Continue palpating the psoas
trunk at the lumbar spinal joints. major toward its superior vertebral attachment and
inferiorly as far as possible within the abdominopelvic
Iliacus cavity.
Q Flexes the thigh. Note: The psoas major can also be palpated with the client
Q Laterally rotates the thigh. supine with a roll under the knees (see Figure 10-16, B).
Q Anteriorly tilts the pelvis. 6. To palpate the iliacus, curl your fingers around the iliac
crest with your finger pads oriented toward the internal
Psoas Major surface of the ilium. Feel for the iliacus (Figure 10-17).
To engage the iliacus, ask the client to flex the thigh at
Q Flexes the thigh.
the hip joint by lifting the foot slightly off the floor.
Q Laterally rotates the thigh.
7. The distal belly of the iliopsoas is also palpable in the
Q Anteriorly tilts the pelvis. proximal anterior thigh between the pectineus and the
Q Flexes the trunk. sartorius (Figure 10-18).
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10
A B
FIGURE 10-16 A, Palpation of the right psoas major as the client gently flexes the thigh at
the hip joint by lifting her foot up slightly from the floor. B, The psoas major can also be
palpated with the client supine or side lying. The disadvantage of the supine palpation
position is that when the client flexes the thigh at the hip joint, the muscles of the abdominal
wall may contract to stabilize the pelvis. This action can interfere with feeling the psoas
major, located deep to these muscles. This action may also occur to some degree with the
side-lying palpation position.
FIGURE 10-17 The right iliacus is palpated by curling the fingers FIGURE 10-18 Palpation of the distal belly and tendon of the
around the iliac crest so that the finger pads are oriented psoas major in the proximal thigh (immediately distal to the
against the muscle. inguinal ligament) as the client flexes (curls) the trunk at the
spinal joints against gravity. The sartorius has been ghosted in.
Q With regard to posture, a chronically tight iliopsoas anteriorly Q You must be careful with
tilts the pelvis, causing the lumbar curve to increase palpation of the distal
(hyperlordosis, also known as swayback). belly of the iliopsoas in
Straight-legged sit-ups the proximal thigh
tend to strengthen the because the femoral
iliopsoas disproportion- nerve, artery, and vein
ately in comparison to lie over the iliopsoas
the anterior abdominal and pectineus in the
wall muscles. To avoid this, femoral triangle here.
curl-ups are recommended, Q Be careful when palpating deep
wherein the hip and knee joints are flexed and the trunk into the abdominal cavity for the
“curls” up (flexes) approximately 30 degrees. belly of the psoas major; major blood
Q The roots of the lumbar plexus of nerves enter and pierce vessels (aorta and iliac arteries) are located nearby. If you feel
the psoas major muscle. Therefore a tight psoas major may a pulse under your fingers, move your palpating fingers off
entrap these nerves. the artery.
Q Tenderloin (also known as filet mignon) is the psoas major Q The psoas major is usually cited as a flexor of the lumbar
of a cow. spine because it crosses anteriorly to the axis of motion
for the lumbar vertebrae. However, if the client has a
hyperlordotic lumbar spine (swayback), the relationship of
the psoas major’s fibers relative to the joints can change
such that it crosses posteriorly and is now an extensor. 10

Psoas Minor
Pronunciation 3/ AS-9 NOR
The psoas minor is a small muscle that lies

anteriorly on the belly of the psoas major
in the abdominal cavity (Figure 10-19).
10
O
Psoas minor
FIGURE 10-19 Anterior view of the psoas minor bilaterally. The psoas major has been ghosted in on
the left. O, Origin; I, insertion.

The name, psoas minor, tells us that this muscle is Origin (Proximal Attachment)
located in the low back area and is smaller than the
Q Anterolateral bodies of T12 and L1
psoas major.
Derivation:
psoas: Gr. loin (low back)
Q Pubis
minor: L. smaller
ACTIONS TREATMENT CONSIDERATIONS

The psoas minor moves the trunk at the spinal joints Q The psoas minor
Where
and the pelvis at the lumbosacral joint. is absent in has it
approximately 40% gone?
Q Flexes the trunk. of the population.
Q Posteriorly tilts the pelvis. Q A condition, called
psoas minor syndrome,
STABILIZATION has been reported, in
which the psoas minor
1. Stabilizes the lumbar spinal joints. in teenagers has not
kept up with the growth
2. Stabilizes the pelvis.
of the trunk and pelvis and is,
consequently, pulled taut and
becomes painful.
INNERVATION
Q L1 Spinal nerve
PALPATION
10
1. Locate the psoas major, and then feel for a small
band of muscle that sits anteriorly on it. To discern
these two muscles from each other, feel for a band
of musculature on the psoas major that does not
contract with flexion of the thigh at the hip joint.
MUSCLES OF THE PELVIS AND THIGH: Adductor Group

Adductor Longus; Adductor Brevis; Adductor Magnus;
Pectineus; Gracilis
Pronunciation AD $5+ TOR,/.' US s AD $5+ TOR"2% VIS s AD $5+ TOR-!' NUS s
PEK 4). EE US s GRA 3), IS
The adductor group is composed of five muscles: the adductors

longus, brevis, and magnus, and the pectineus and gracilis. All five
muscles cross the hip joint and perform adduction of the thigh
at the hip joint, hence the name of the group. The gracilis also
crosses the knee joint. In lay terms, these muscles are referred to as
groin muscles. The proximal aspects of the pectineus and adductor
longus are superficial in the anteromedial thigh. The adductor
brevis is deep to the longus. The gracilis is superficial for its entire
course in the medial thigh. The adductor magnus has two heads,
10 an anterior and posterior head, and is sandwiched between the
other adductors anteriorly and the hamstrings posteriorly. A small
portion of it is superficial in the medial thigh (Figure 10-20).
Adductor
longus
Adductor
brevis
A B
FIGURE 10-20 A, Anterior view of the right adductor longus. The pectineus has been cut and
ghosted in. B, Anterior view of the right adductor brevis. The adductor longus has been cut and
ghosted in on the left.
Pectineus O
O
Anterior
O
head
Posterior I
head
I Gracilis
10
C D E
FIGURE 10-20, cont'd C, Posterior view of the right adductor magnus. D, Anterior view of the
right pectineus. The adductor longus has been cut and ghosted in. E, Anterior view of the right
gracilis. The adductor longus has been cut and ghosted in. O, Origin; I, insertion.

The name, adductor longus, tells us that this muscle All five muscles of the adductor group originate on
is an adductor and longer than the adductor brevis. (attach proximally to) the pubic bone. The adductor
The name, adductor brevis, tells us that this magnus also attaches proximally to the ischium.
muscle is an adductor and shorter than the adductor
longus.
The name, adductor magnus, tells us that this Adductors Longus and Brevis
muscle is an adductor and larger than the adductor
longus and adductor brevis.
The name, pectineus, means comb. The pectinus
Q Pubis
has a comblike appearance because its muscle fibers
form a flat surface as they leave the pubic bone. Insertion (Distal Attachment)
The name, gracilis, tells us that the shape of this Q Linea aspera of the femur
muscle is slender and graceful.
Derivation:
adductor: L. muscle that adducts a body part Adductor Magnus
longus: L. longer Origin (Proximal Attachment)
brevis: L. shorter
Q Pubis and ischium
magnus: L. great, larger
pectineus: L. comb
gracilis: L. slender, graceful Insertion (Distal Attachment)
Q Linea aspera of the femur
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Pectineus PALPATION
Origin (Proximal Attachment) 1. The palpation position for all of the muscles of the
Q Pubis adductor group is to have the client supine with
the thighs on the table and the legs hanging off the
Insertion (Distal Attachment) table.
Q Proximal posterior shaft of the femur Note: If this position is uncomfortable for the client, the foot
the table to stabilize the pelvis and low back.
Gracilis
Q Pubis Adductors Longus and Brevis
Insertion (Distal Attachment) legs hanging off the table.
Q Pes anserine tendon at the proximal anteromedial 2. The proximal tendon of the adductor longus is the
tibia most prominent tendon in the medial thigh and is
usually easily palpable. To locate it, simply palpate
along the pubic bone from lateral to medial until you
10 ACTIONS encounter a prominent tendon. Place your palpating

finger pads on the prominent tendon of the adductor
The muscles of the adductor group move the thigh and longus in the proximal anterior thigh. Place the
pelvis at the hip joint. The gracilis also moves the leg resistance hand on the distal anteromedial thigh, just
and thigh at the knee joint. proximal to the knee joint.
3. Ask the client to adduct the thigh at the hip joint
Adductors Longus and Brevis, against resistance. Feel for the tendon to tense
(Figure 10-21).
Pectineus, and Gracilis
4. Strum perpendicular to the tendon to palpate its
Q Adduct the thigh at the hip joint.
width. Continue to palpate it distally as far as possible
Q Flex the thigh at the hip joint. toward its linea aspera attachment.
Q Anteriorly tilt the pelvis at the hip joint. 5. The adductor brevis is difficult to palpate and discern
Q The gracilis also flexes the knee joint. from the adductor longus. Try to palpate it either deep
to the adductor longus or between the adductor
longus and adjacent gracilis (Figure 10-22).
Adductor Magnus
Q Adducts the thigh at the hip joint.
Q Extends the thigh at the hip joint.
Q Posteriorly tilts the pelvis at the hip joint.
STABILIZATION
1. All muscles of the adductor group stabilize the thigh
and pelvis at the hip joint.
2. The gracilis also stabilizes the knee joint.
INNERVATION
Q Obturator nerve (adductors longus and brevis;
gracilis)
FIGURE 10-21 Engagement and palpation of the right adductor
Q Obturator nerve and sciatic nerve (adductor magnus) longus as the client adducts the thigh at the hip joint against
Q Femoral nerve (pectineus) resistance.
Pectineus Adductor Magnus

1. The client is supine with the thighs on the table and 1. The client is supine with the thighs on the table and
legs hanging off the table. the legs hanging off the table.
2. Place your palpating finger pads on the proximal 2. The adductor magnus is actually quite easily palpable
tendon of the adductor longus. Now drop off of it in the proximal medial thigh between the gracilis
anteriorly (laterally), and you will be on the pectineus. and the hamstring muscles, where it is located in a
Staying close to the pubic bone is important. Place depression between these muscles.
your resistance hand on the distal anteromedial thigh, 3. Locate the adductor magnus by first locating the
just proximal to the knee joint. gracilis and medial hamstrings, which contract with
3. Ask the client to adduct the thigh against resistance flexion of the leg at the knee joint performed by
and feel for the pectineus to engage (Figure 10-23). asking the client to press the leg against the table
4. Once located, strum perpendicular to the fibers; con- (Figure 10-25, A). Once you feel these muscles
tinue palpating the pectineus distally as far as possible. palpably harden with leg flexion, feel for the adductor
magnus between them (it will stay relaxed and soft
Note: Other than the adductor brevis, the pectineus is the during this joint action) (Figure 10-25, B).
most challenging member of the adductor group to palpate
and discern.
Gracilis 10
1. The client is supine with thighs on the table and legs
hanging off the table.
2. Place your palpating finger pads on the proximal
tendon of the adductor longus. Then drop just off of it
posteriorly (medially), and you will be on the gracilis.
3. Ask the client to flex the leg at the knee joint against
the table. Flexion of the leg at the knee joint will
engage the gracilis but not the adductor longus and
adductor magnus on either side of it, making it easy
to discern the gracilis in the proximal thigh (Figure
10-24). FIGURE 10-23 Engagement and palpation of the right pectineus
as the client adducts the thigh against resistance.
4. Once located, strum perpendicular to the fibers;
continue palpating the gracilis distally to the tibia.
FIGURE 10-22 Palpation of the right adductor brevis proximally FIGURE 10-24 Engagement and palpation of the right gracilis as
between the adductor longus (ghosted in) and gracilis as the the client flexes the leg against the resistance of the table.
client adducts the thigh against resistance.
Turn page to 'more.

Q The medial border of the adductor longus is the medial

Adductor magnus
border of the femoral triangle of the thigh. The femoral
Gracilis triangle is located between the medial borders of the
sartorius and adductor longus and contains the femoral
Medial hamstrings
nerve, artery, and vein.
Q The adductor longus has
the most prominent
proximal tendon in the
groin region, which can
serve as a useful land-
mark for locating the
pectineus, gracilis,
and adductor
A magnus.
Q The adductor magnus
has an anterior head
and a posterior head, with a hiatus between them, through
which the femoral artery and vein from the anterior thigh
pass, becoming the popliteal artery and vein in the distal
posterior thigh.
Hey guys, can I
Q Similar to the hamstring join your group?
10 muscles, the adductor THE
magnus attaches to HAMSTRINGS
S
the ischial tuberosity MAGNU
and can extend the
thigh at the hip joint.
For this reason, the
B
adductor magnus (or
more specifically, the
FIGURE 10-25 Palpation of the right adductor magnus in the posterior head of the
medial thigh between the gracilis and medial hamstrings. A, The adductor magnus) is
gracilis and medial hamstrings engage when the client flexes sometimes referred to
the leg at the knee joint by pressing the leg against the table. as the fourth hamstring.
B, Engagement and palpation of the adductor magnus occurs
Q Be careful when palpating the proximal anterior thigh,
between these muscles as the client extends the thigh at the
hip joint by pressing the thigh down against the table. because the femoral nerve, artery, and vein are located
over the iliopsoas and pectineus in this region. If you feel
a pulse under your fingers, either gently move the artery
out of the way or slightly move your palpating fingers off
4. To engage the adductor magnus and confirm that
the artery. Similarly, if you are pressing on the femoral
you are on it, ask the client to extend the thigh at the nerve and the client feels shooting pain, move your
hip joint against the resistance of the table (see Figure palpating fingers off the nerve.
10-25, B).
5. Continue palpating the adductor magnus distally as
far as possible by strumming perpendicular to the
fibers as the client alternately contracts and relaxes it.
Q The gracilis is one of
three muscles that
attach into the pes
anserine tendon.
Pes anserine means
goose foot. The other
two muscles that attach
here are the sartorius
and semitendinosus.
Notes
MUSCLES OF THE PELVIS AND THIGH:

Quadriceps Femoris Group (Quads)
Rectus Femoris; Vastus Lateralis; Vastus Medialis;
Vastus Intermedius
Pronunciation 2%+ TUS&%- O RIS s 6!3 TUSLAT ER ! LIS s 6!3 TUSMEE DEE ! LIS s
6!3 TUSIN TER -%% DEE US
The quadriceps femoris group, or as they are usually known, the

quads, are a group of four muscles that are superficial in the anterior
thigh but reach around medially and laterally to attach posteriorly
to the linea aspera of the femur. Therefore they envelop nearly the
entire femur. The four muscles of the quads are the rectus femoris,
vastus lateralis, vastus medialis, and the vastus intermedius (Figure
10-26). All four quads cross the knee joint; only the rectus femoris
crosses the hip joint. The vastus lateralis is the largest of the four
10 quadriceps femoris muscles.
Rectus femoris
Vastus lateralis Vastus

lateralis
Vastus medialis
I
I
A B
FIGURE 10-26 A, Anterior view of the rectus femoris bilaterally. The rest of the quadriceps femoris
group has been ghosted in on the left. B, Anterior view of the vastus lateralis bilaterally. The rest of
the quadriceps femoris group has been ghosted in on the left.
Vastus
Vastus medialis intermedius
C D
10
FIGURE 10-26, cont'd C, Anterior view of the vastus medialis bilaterally. The rest of the quadriceps
femoris group has been ghosted in on the left. D, Anterior view of the vastus intermedius bilaterally.
The vastus lateralis and vastus medialis have been ghosted in on the left. O, Origin; I, insertion.
WHAT’S IN A NAME? Rectus Femoris

The name, rectus femoris, tells us that the fibers of Origin (Proximal Attachment)
this muscle run straight up and down (proximal to Q Anterior inferior iliac spine (AIIS)
distal) on the femur.
The name, vastus lateralis, tells us that this muscle Insertion (Distal Attachment)
is vast in size and located laterally. Q Tibial tuberosity via the patella and the patellar
The name, vastus medialis, tells us that this ligament
muscle is vast in size and located medially.
The name, vastus intermedius, tells us that this
muscle is vast in size and located between the two Vastus Lateralis and Vastus Medialis
other vastus muscles.
Derivation: Origin (Proximal Attachment)
rectus: L. straight Q Linea aspera of the femur
femoris: L. refers to the femur
vastus: L. vast
lateralis: L. lateral Q Tibial tuberosity via the patella and the patellar
medialis: L. medial ligament
inter: L. between
medius: L. middle
Vastus Intermedius
Q Anterior shaft and linea aspera of the femur
ATTACHMENTS Insertion (Distal Attachment)
All four quads insert on (attach distally to) the tibial Q Tibial tuberosity via the patella and the patellar
tuberosity via the patella and patellar ligament. ligament
ACTIONS
All four quads move the leg or thigh at the knee joint.
The rectus femoris also moves the thigh or pelvis at the
hip joint.
Q Extend the leg at the knee joint.
Q Extend the thigh at the knee joint.
The rectus femoris also:
Q Flexes the thigh at the hip joint.
Q Anteriorly tilts the pelvis at the hip joint.
A
STABILIZATION
Q All four quads stabilize the knee joint.
Q The rectus femoris also stabilizes the pelvis and thigh
at the hip joint.
INNERVATION
10
Q Femoral nerve
PALPATION B
The palpation position for all of the muscles of the

quadriceps femoris group is to have the client supine with
the thighs on the table and the legs hanging off the table.
If this position is uncomfortable for the client, the foot of the
lower extremity not being palpated can be placed on the
table to stabilize the pelvis and low back.

the legs hanging off the table. Place your palpating
finger pads midline on the anterior thigh. If resistance
is necessary, place the resistance hand on the distal
leg, just proximal to the ankle joint. C
2. Ask the client to extend the leg at the knee joint. Feel for
the contraction of the rectus femoris (Figure 10-27, A). FIGURE 10-27 Anterior views of palpation of the quadriceps
femoris muscles as the client extends the leg at the knee joint.
3. Continue palpating the rectus femoris distally to the A, Palpation of the rectus femoris. B, Palpation of the vastus
tibial tuberosity and proximally toward the anterior medialis. C, Palpation of the vastus lateralis.
inferior iliac spine (AIIS) by strumming perpendicular
to it.
Note: Palpating the origin (proximal attachment) at the AIIS contraction. Then strum perpendicular to the fibers,
is challenging. and palpate the vastus lateralis in the anterolateral
thigh, in the lateral thigh deep to the iliotibial band
4. For the vastus medialis, palpate in the anteromedial (ITB), and in the posterolateral thigh immediately
thigh, just proximal to the patella while the client posterior to the ITB (Figure 10-27, C).
extends the leg at the knee joint. Feel for its con- 6. The vastus intermedius is difficult to palpate and
traction. Then strum perpendicular to the muscle, discern from the rectus femoris. If the rectus femoris
and palpate as much of the vastus medialis as can be lifted and/or moved aside, the distal vastus
possible (Figure 10-27, B). intermedius may be palpated deep to the rectus
5. For the vastus lateralis, palpate in the anterolateral femoris when approached from either the medial or
thigh, just proximal to the patella while the client the lateral side. Make sure that the direction of your
extends the leg at the knee joint. Feel for its pressure is oriented toward the middle of the femur.
Q Because of the difference in leverage, the rectus femoris is Q The most distal aspect
more powerful at the knee joint than at the hip joint. of the vastus medialis
is the bulkiest and may
MISS
Q Pain attributed to the form a bulge in well-toned
ITB is often caused individuals.
by tightness of the 1st
vastus lateralis, which Q Strengthening the
quadriceps femoris
ER
is deep to the ITB.
SE
group is a major factor
Q Some sources refer in knee joint stabilization
to the upper fibers of or physical rehabilitation
the vastus medialis work.
as the vastus medialis
longus (VML) and the
lower fibers as the
vastus medialis
oblique (VMO) because of the drastic difference in the
direction of the upper fibers compared with the lower fibers.
10

Articularis Genus
Pronunciation AR 4)+ YOU ,! RIS*% NEW
ATTACHMENTS
The articularis genus is a very thin muscle
that is located on the distal anterior femur Origin (Proximal Attachment)
deep to the quadriceps femoris musculature Q Anterior distal femoral shaft
(Figure 10-28).
Q Knee joint capsule
O
Articularis genus ACTION
Joint capsule
I Tenses and pulls the knee joint capsule proximally.
Patella STABILIZATION
10 Stabilizes the position of the knee joint capsule.
INNERVATION
Q Femoral nerve
FIGURE 10-28 Anterior view of the right articularis genus.

PALPATION
Q The articularis genus is a small muscle deep to
the rectus femoris and vastus intermedius and is
WHAT’S IN A NAME? extremely difficult, if not impossible, to palpate and
distinguish from the adjacent musculature.
The name, articularis genus, tells us that this muscle
is involved with the knee joint.
Derivation:
articularis: L. refers to a joint TREATMENT CONSIDERATIONS
genu: L. refers to the knee Q The articularis genus works in concert with the quadriceps
femoris musculature. When the quads contract and pull
the patella proximally along the femur, the anterior genus
contracts to pull the knee joint capsule proximally so that it
does not become pinched between the patella and the femur.
Notes
MUSCLES OF THE PELVIS AND THIGH: Hamstring Group

Biceps Femoris; Semitendinosus; Semimembranosus
Pronunciation "9 SEPS&%- O RIS s 3%- I 4%. DI ./ SUS s 3%- I -%- BRA ./ SUS
The hamstring group is composed of three muscles: biceps

femoris, semitendinosus, and semimembranosus (Figure 10-29).
The biceps femoris has two heads, a long head and a short head.
The semitendinosus and semimembranosus are located medially
and referred to as the medial hamstrings; the two heads of the
biceps femoris are located laterally and referred to as the lateral
hamstrings. Except at their origin (proximal attachment) at the
ischial tuberosity where they are deep to the gluteus maximus, the
hamstring group is superficial in the posterior thigh. Within the
group, on the medial side, the semitendinosus is superficial to the
semimembranosus; on the lateral side, the long head of the biceps
10 femoris is superficial to the short head. The semimembranosus is
the largest of the three hamstrings.
O O
O
O Semitendinosus
Long
head
Semimembranosus
Short
Short head
head
I I I I
A B C D
FIGURE 10-29 Posterior views of the right hamstrings. A, The long and short heads of the biceps
femoris. The semitendinosus has been ghosted in. B, The short head of the biceps femoris.
The semimembranosus has been ghosted in. C, The right semitendinosus. The biceps femoris
has been ghosted in. D, The right semimembranosus. The proximal and distal tendons of the
semitendinosus have been cut and ghosted in. O, Origin; I, insertion.

The name, biceps femoris, tells us that this muscle All hamstring muscles move the leg or thigh at the
has two heads and lies over the femur. knee joint. All hamstring muscles (except the short
The name, semitendinosus, tells us that this head of the biceps femoris) move the thigh or pelvis
muscle has a long, slender (distal) tendon. at the hip joint.
The name, semimembranosus, tells us that this Q Flex the leg at the knee joint.
muscle has a flattened, membranous (proximal)
Q Extend the thigh at the hip joint.
attachment.
Derivation:
Q Posteriorly tilt the pelvis at the hip joint.
biceps: L. two heads
femoris: L. refers to the femur STABILIZATION
semitendinosus: L. refers to its long tendon 1. Stabilize the thigh and pelvis at the hip joint.
semimembranosus: L. refers to its flattened,
2. Stabilize the knee joint.
membranous tendon
INNERVATION
Q Sciatic nerve
ATTACHMENTS
10
All hamstrings (except for the short head of the biceps PALPATION
femoris) originate on (attach proximally to) the ischial
tuberosity of the pelvic bone. 1. The client is prone with the leg partially flexed at the
knee joint. Place your palpating finger pads just distal
to the ischial tuberosity. Place the resistance hand
Biceps Femoris around the distal leg, just proximal to the ankle joint.
Origin (Proximal Attachment) 2. Ask the client to try to flex the leg at the knee joint
Q Ischial tuberosity (long head) against gentle-to-moderate resistance. Feel for the
contraction of the hamstrings.
Q Linea aspera (short head)
3. Strumming perpendicular to the fibers, follow the
Insertion (Distal Attachment) biceps femoris toward the head of the fibula (Figure
10-30, A). Repeat this procedure from the ischial
Q Head of the fibula
tuberosity to follow the medial hamstrings toward the
medial side of the leg (Figure 10-30, B).
Semitendinosus

Q Pes anserine tendon (at the proximal anteromedial
tibia)
Semimembranosus
A
Q Ischial tuberosity FIGURE 10-30 Palpation of the superficial hamstring muscles of
the right thigh as the client attempts to flex the leg at the knee
Insertion (Distal Attachment) joint against resistance. A, Palpation of the long head of the
biceps femoris on the lateral side. Continued
Q Posterior surface of the medial condyle of the tibia
Turn page to 'more.

Q The semimembranosus also attaches into the medial

meniscus of the knee joint and facilitates the movement of
the medial meniscus during knee flexion. This helps prevent
impingement of the medial meniscus between the femur
and tibia.
Q The semitendinosus is
one of three muscles
that attach into the pes
anserine tendon; pes
anserine means goose
foot. The other two
muscles that attach
here are the sartorius
B and the gracilis.
FIGURE 10-30, cont'd Palpation of the superficial hamstring

muscles of the right thigh as the client attempts to flex the
leg at the knee joint against resistance. B, Palpation of the
semitendinosus on the medial side.
Note: The semimembranosus inserts on the posterior sur-

face of the medial condyle of the tibia; the semitendinosus
10 attaches anteriorly on the tibia at the pes anserine tendon.
Q The semitendinosus
is named for its long
distal tendon.
Q The semimembranosus
is named for its
flattened, membranous
proximal tendon.
REVIEW QUESTIONS
1. What are the three muscles of the hamstring group? 6. What is the only quadriceps femoris muscle that
crosses the hip joint?
________________________________________________ a. Vastus lateralis
b. Vastus medialis
________________________________________________ c. Vastus intermedius
d. Rectus femoris
________________________________________________
7. What is the most inferior member of the deep
2. What are the four muscles of the quadriceps lateral rotator group of the hip joint?
femoris group? a. Piriformis
b. Obturator internus
________________________________________________ c. Inferior gemellus
d. Quadratus femoris
________________________________________________
8. Which of the following muscles can flex, abduct,
________________________________________________ and medially rotate the thigh at the hip joint?
a. Rectus femoris 10
________________________________________________ b. Sartorius
c. TFL
3. What are the three muscles of the gluteal group? d. Piriformis
________________________________________________ 9. Which of the following muscles can anteriorly tilt

the pelvis at the hip joint?
________________________________________________ a. Rectus femoris
b. Gluteus maximus
________________________________________________ c. Piriformis
d. Vastus medialis
4. What is the only muscle of the deep lateral rotator
group of the hip joint that attaches to the sacrum? 10. Which one of the following muscles attaches into
a. Quadratus femoris the pes anserine tendon?
b. Obturator externus a. Sartorius
c. Piriformis b. TFL
d. Superior gemellus c. Rectus femoris
d. Gluteus maximus
5. Which one of the following muscles is the lateral
hamstring muscle?
a. Semitendinosus
b. Rectus femoris
c. Biceps femoris
d. Semimembranosus
CASE STUDY 1
Julia, a 38-year-old woman and competitive cyclist, is QUESTIONS
experiencing pain on the lateral side of her right thigh from
her greater trochanter to her knee joint. The pain is most 1. What soft tissue is likely dysfunctional?
intense when she is cycling and shortly thereafter. On a pain
______________________________________________________
scale of 0 to 10, she rates the pain at a 6 or 7. She uses
ice and heat to reduce pain and takes over-the-counter ______________________________________________________
ibuprofen to manage the pain as needed.
Julia has had no traumatic injury to the region. She ______________________________________________________
has trained for and competed in races for 7 years. Her
______________________________________________________
weekly training regimen had always consisted of twice
daily training, Monday through Thursday, resting on ______________________________________________________
Friday, prolonged training on Saturday, and resting again
on Sunday. Additionally, she has done weight training on ______________________________________________________
Monday and Thursday. However, approximately 1 month ______________________________________________________
earlier in preparation for an upcoming event, she recently
decided to eliminate the second rest day on Sunday and
2. Why did Julia develop this problem now?
replace it with a second long workout. Her lateral thigh
pain began to develop 2 weeks ago and has progressively ______________________________________________________
10 worsened.
On palpation, the tissue of the lateral thigh was found to ______________________________________________________
be hard and taut. Further, palpation elicited pain at a level
______________________________________________________
of approximately 4 to 7 in the middle of the lateral thigh.
______________________________________________________
______________________________________________________
______________________________________________________
______________________________________________________
______________________________________________________
______________________________________________________
CASE STUDY 2
A 46-year-old white-collar male client is experiencing sharp 2. Assuming the musculature you assess is tight, what
shooting sciatic pain that begins in his right gluteal region modalities do you use to treat this client?
and shoots down his posterior thigh to the level of his knee
joint. He also complains of a general feeling of stiffness in ______________________________________________________
his right low back and buttock. No precipitating trauma ______________________________________________________
occurred to begin this condition. Rather, the pain insidiously
began approximately 4 weeks earlier and has been steadily ______________________________________________________
increasing ever since.
______________________________________________________
He first visited his medical physician, who then referred
him to an orthopedist. The orthopedist ordered a magnetic ______________________________________________________
resonance image (MRI) of the lumbar spine, which showed
negative for any involvement of the spine. Without a ______________________________________________________
clear diagnosis, the orthopedist recommended a 2-week
______________________________________________________
prescription of an antiinflammatory medication, which the
client has declined to take. 3. Do you suspect the involvement of any other
On a pain scale of 0 to 10, the pain varies from a level condition?
of 2 to 7. Pain and stiffness are worst in the morning when
he first awakes (pain level of 7). After taking a hot shower ______________________________________________________
and stretching in the morning, the pain and stiffness largely
______________________________________________________ 10
subside and he feels pretty good (pain level of 2). However,
as the day goes by, his pain level gradually increases until by ______________________________________________________
the end of the day; he is back at a level of 7. He states that
sitting aggravates the condition, and that driving is the worst. ______________________________________________________
When asked to identify the location of the pain, he ______________________________________________________
points to the center of the right buttock as the location
from which the sharp sciatic pain emanates. He also points ______________________________________________________
to his right sacroiliac joint as another place where he feels
pain; he states that here, the pain is more of a dull ache. ______________________________________________________
4. In addition to your in-session treatment, what home

QUESTIONS advice would you give this client?
1. What musculature should you assess? Why? ______________________________________________________
______________________________________________________ ______________________________________________________
______________________________________________________ ______________________________________________________
______________________________________________________ ______________________________________________________
______________________________________________________ ______________________________________________________
______________________________________________________ ______________________________________________________
______________________________________________________ ______________________________________________________
CHAPTER
Muscles of the Leg and Foot
11
CHAPTER OUTLINE
Overview of Function: Muscles of the Ankle and INTRINSIC FOOT MUSCLES
Subtalar Joints, 386 Dorsal Surface, 416
Overview of Function: Muscles of the Toes, 386 Extensor Digitorum Brevis
Extensor Hallucis Brevis
LEG/EXTRINSIC FOOT MUSCLES
Plantar Layer I, 418
Tibialis Anterior, 394
Abductor Hallucis
Extensor Hallucis Longus, 396
Abductor Digiti Minimi Pedis
Extensor Digitorum Longus, 398
Flexor Digitorum Brevis
Fibularis Group, 400
Plantar Layer II, 422
Fibularis Longus
Quadratus Plantae
Fibularis Brevis
Lumbricals Pedis
Fibularis Tertius
Plantar Layer III, 424
Triceps Surae Group, 404
Flexor Hallucis Brevis
Gastrocnemius
Flexor Digiti Minimi Pedis
Soleus
Adductor Hallucis
Plantaris, 408
Plantar layer IV, 428
Tom, Dick, and Harry Group, 410
Plantar Interossei
Tibialis Posterior
Dorsal Interossei Pedis
Flexor Digitorum Longus
Flexor Hallucis Longus
Popliteus, 414
T he muscles of this chapter are primarily involved

with motions of the foot at the ankle and subta-
lar joints and/or the motions of the toes at the meta-
The deep posterior compartment contains the
tibialis posterior, flexor digitorum longus, flexor hallu-
cis longus, and popliteus. Some of these muscles are
tarsophalangeal (MTP) and interphalangeal (IP) joints. addressed in other chapters.
As a rule, muscles that move the foot originate The location by compartment helps determine the
(attach proximally) and have their bellies in the leg. Leg actions of these muscles. For example, all muscles
muscles are usually divided into the four fascial com- of the anterior compartment perform dorsiflexion; all
partments of the leg: anterior, lateral, superficial poste- muscles of the lateral and posterior compartments
rior, and deep posterior. perform plantarflexion; and all muscles of the lateral
The anterior compartment contains the tibialis compartment perform eversion. The final determination
anterior, extensor digitorum longus, extensor hallucis of exactly what the actions of a muscle of the ankle
longus, and fibularis tertius. and subtalar joints will be is where the distal tendon of
The lateral compartment contains the fibularis that muscle crosses these joints (e.g., the belly of the
longus and fibularis brevis. tibialis anterior is located in the anterolateral leg, but its
The superficial posterior compartment contains tendon crosses the subtalar joint medially; therefore it
the gastrocnemius, soleus, and plantaris. inverts the foot).
385
Muscles that move the toes are usually divided Q If a muscle crosses the subtalar joint medially, it
into long extrinsic foot muscles and short intrinsic can invert the foot at the subtalar joint by moving
foot muscles. Extrinsic foot muscles originate (attach the medial surface of the foot toward the medial
proximally) in the leg or thigh and insert (attach distally) surface of the leg. Note: Inversion is the principle
in the foot. Intrinsic foot muscles originate and insert component of supination.
(attach proximally and distally) in the foot; in other Q Reverse actions occur when the foot is planted on
words, they are wholly located in the foot. The intrinsics the ground and the leg must move relative to the
of the foot are divided into dorsal and plantar muscles. foot. The same terms can be used to describe these
Generally, dorsal muscles extend the toes; plantar reverse actions. For example, when the anterior
muscles flex the toes. The plantar muscles are further (dorsal) surface of the leg moves toward the dor-
divided into four layers, named Layers I through IV, from sum of the foot, it is called dorsiflexion of the leg at
superficial to deep. The term digitorum refers to toes the ankle joint.
two through five; the term hallucis refers to the big toe.
you to examine the muscles of this body region, layer
by layer, and individual muscle palpation technique
videos are available in the Chapter 11 folder on the OF THE TOES
Evolve website. The following general rules regarding actions can be
stated for the functional groups of toe muscles:
Q Toes two through five can move at three joints: the
11 OVERVIEW OF FUNCTION: MUSCLES MTP, proximal interphalangeal (PIP), and distal
OF THE ANKLE AND SUBTALAR interphalangeal (DIP) joints. The big toe (toe one)
JOINTS can move at two joints: the MTP and IP joints.
Q To move a joint of the toe, the muscle must cross
The following general rules regarding actions can be that joint; therefore knowing the attachments of
stated for the functional groups of muscles of the the toe muscles determines which toe joints can be
ankle and subtalar joints: moved by that muscle.
Q If a muscle crosses the ankle joint anteriorly with Q If a muscle crosses the joints of the toes on the
a vertical direction to its fibers, it can dorsiflex the plantar side, it can flex the toe at the joint(s)
foot at the ankle joint by moving the dorsum of the crossed; if a muscle crosses joints of the toes on
foot toward the anterior (dorsal) surface of the leg. the dorsal side, it can extend the toe at the joint(s)
Q If a muscle crosses the ankle joint posteriorly with a crossed.
vertical direction to its fibers, it can plantarflex the Q Reverse actions involve the origin (proximal
foot at the ankle joint by moving the plantar surface attachment) moving toward the insertion (distal
of the foot toward the posterior surface of the leg. one). This occurs when the distal end of the foot
Q If a muscle crosses the subtalar joint laterally, it can is fixed, usually when the foot is planted on the
evert the foot at the subtalar joint by moving the ground (for example, when we toe-off during the
lateral surface of the foot toward the lateral surface gait cycle, the metatarsals of the toes extend toward
of the leg. Note: Eversion is the principle compo- the proximal phalanger, and therefore the foot
nent of pronation. extends toward the toes at the MTP joints).
Anterior View
of the Muscles
of the Right Ankle Iliotibial band (ITB)
and Subtalar Joints
Patella
Head of fibula
Pes anserine tendon
Fibularis longus
Gastrocnemius medial head
Tibialis anterior
11
Soleus
Fibularis brevis

Fibularis tertius

Superior and inferior
extensor retinacula
Lateral malleolus of fibula
FIGURE 11-1 Anterior view of the muscles of the right ankle and subtalar joints.
387
Posterior View
of the Muscles Femoral artery and vein, tibial nerve
of the Right Ankle
and Subtalar Joints—
Superficial
Plantaris
Gastrocnemius lateral head

Gastrocnemius medial head
11
Soleus
Fibularis longus
Plantaris tendon
Fibularis brevis

Medial malleolus of tibia Calcaneus
Tibialis posterior
Fibularis brevis tendon
Tibialis anterior
Flexor digitorum longus tendon

Fibularis longus tendon
FIGURE 11-2 Posterior view of the muscles of the right ankle and subtalar joints. A, Superficial view.
388
Posterior View Sciatic nerve
Popliteal
of the Muscles artery
and vein
of the Right Ankle Tibial nerve
and Subtalar
Joints—Deep Common fibular nerve
Medial femoral condyle
Head of fibula
Tibialis posterior
11

Medial malleolus of tibia

Tibialis posterior
Flexor
hallucis longus
FIGURE 11-2, cont'd Posterior view of the muscles of the right ankle and subtalar joints.
B, Deep view.
389
Lateral and Medial Views
of the Muscles of the Right
Ankle and Subtalar Joints
Iliotibial band (ITB)
Patella
Head of fibula Infrapatellar ligament
Gastrocnemius
lateral head
Tibialis anterior
Extensor digitorum
Soleus longus
11 Fibularis longus Fibularis tertius
Retinacular fibers
Superior extensor Patella
retinaculum
Fibularis brevis
Extensor hallucis
longus tendon
Flexor hallucis
Inferior extensor
longus Pes anserine
retinaculum
tendon
Calcaneal
(Achilles) tendon
Extensor digitorum
longus tendons Tibialis anterior Gastrocnemius
Superior fibular medial head
retinaculum Fibularis
tertius
Calcaneus tendon
Tibia
Inferior fibular Cuboid Fibularis brevis

A retinaculum tendon
Soleus
Tibialis posterior
Flexor digitorum
Superior extensor retinaculum longus
Flexor hallucis
Extensor digitorum longus tendons longus
Medial malleolus
of tibia
1st metatarsal
Inferior extensor
retinaculum
Extensor hallucis
longus tendon Calcaneal
(Achilles) tendon
B Flexor retinaculum
FIGURE 11-3 A, Lateral view of the muscles of the right ankle and subtalar joints. B, Medial views
of the muscles of the right ankle and subtalar joints—superficial.
390
Compartments ANTERIOR
Anterior Compartment:
of the Leg Tibialis Anterior
Extensor Digitorum Longus
and Dorsal Extensor Hallucis Longus
Fibularis Tertius
View Anterior Lateral Compartment:
of the Right Tibia
Compartment
Fibularis Longus
Fibularis Brevis
Foot Lateral
Superficial Posterior
Compartment
Compartment:
Gastrocnemius
Deep Fibula Soleus
Posterior L Plantaris
M
E Compartment A
T Deep Posterior
D Compartment:
I E
R Popliteus
A A
L Tibialis Posterior
L Flexor Digitorum Longus
Superficial
Posterior
Compartment
11
FIGURE 11-4 Transverse plane
cross section (approximately
one-third of the way distal to
the knee joint), illustrating the
four compartments of the leg.
POSTERIOR

Fibularis longus and brevis
Tibialis anterior
Extensor digitorum longus and fibularis tertius
Superior extensor retinaculum

Inferior extensor retinaculum
Inferior fibular retinaculum

Fibularis brevis tendon Extensor hallucis brevis
Base of 5th metatarsal

Abductor hallucis
Abductor digiti minimi pedis Dorsal interossei pedis
Dorsal digital expansion of 2nd toe
FIGURE 11-5 Dorsal view of the right foot.
391
Plantar Views of the Right
Flexor digitorum
longus tendons
Flexor hallucis
Foot—Superficial Fascial
longus tendon and Superficial
Muscular Views
Abductor digiti minimi

pedis tendon
Plantar aponeurosis
Abductor hallucis
Lateral plantar fascia
Tibialis posterior tendon
11 Abductor digiti minimi

pedis Flexor digitorum longus tendon
Talus
Flexor hallucis
longus tendon
Flexor hallucis
Calcaneus longus tendon
A
1st and 2nd dorsal
Flexor digitorum longus tendons interossei pedis
Adductor hallucis
3rd and 4th dorsal interossei pedis
Lumbricals pedis
Flexor hallucis
brevis
3rd plantar interosseus
Abductor hallucis
Flexor digiti minimi pedis Navicular
Abductor digiti minimi pedis Tibialis posterior

tendon
Flexor digitorum
longus tendon
Talus
Calcaneus
Flexor hallucis
longus tendon
B
FIGURE 11-6 Plantar views of the right foot. A, Superficial view, including the fascia. B, Superficial
muscular view.
392
Plantar Views of the Right
1st and 2nd dorsal
interossei pedis
Foot—Intermediate
and Deep Views
Adductor hallucis
3rd and 4th dorsal
interossei pedis
Lumbricals pedis
1st metatarsal
Flexor digiti minimi
pedis Tibialis anterior tendon
Base of 5th metatarsal Flexor digitorum longus tendon
Fibularis longus tendon Navicular

11
Cuboid
Flexor hallucis longus tendon

Quadratus plantae
Talus
Calcaneus
C 1st dorsal interosseus

pedis
2nd, 3rd, and 4th dorsal interossei pedis
Adductor hallucis

1st and 2nd plantar interossei
1st metatarsal
Tibialis anterior tendon

Base of 5th metatarsal
Navicular

Cuboid

tendon (cut)

tendon (cut)
D
FIGURE 11-6, cont'd Plantar views of the right foot. C, Intermediate view. D, Deep view.
393
MUSCLES OF THE LEG AND FOOT

Tibialis Anterior
Pronunciation tib-ee-A-lis an-TEE-ri-or
The tibialis anterior is a superficial muscle WHAT’S IN A NAME?

in the anterior compartment of the leg. It The name, tibialis anterior, tells us that this muscle
lies immediately lateral to the shaft of the attaches to the tibia and is located anteriorly.
tibia (Figure 11-7). Derivation:
tibialis: L. refers to the tibia
ATTACHMENTS
O
11 Q Anterior tibia

Q Medial foot
Tibialis anterior
ACTIONS
Q Dorsiflexes the foot at the ankle joint.
Q Inverts the foot at the subtalar joint.
STABILIZATION
Stabilizes the ankle and subtalar joints.
INNERVATION
Q Deep fibular nerve
I PALPATION
1. The client is supine. Place your resistance hand on
the medial side of the distal foot.
2. Resist the client from dorsiflexing and inverting the
foot. Look for the distal tendon of the tibialis anterior
on the medial side of the ankle joint and foot; it is
usually visible (Figure 11-8, A).
FIGURE 11-7 Anterior view of the right tibialis anterior. O, Origin; 3. Palpate the distal tendon by strumming perpendicular
I, insertion. across it. Continue palpating the tibialis anterior
proximally to the lateral tibial condyle by strumming
perpendicular to the fibers (Figure 11-8, B).
4. Once the tibialis anterior has been located, have the
client relax it and palpate to assess its baseline tone.
Chapter 11 Muscles of the Leg and Foot 395
A B
FIGURE 11-8 A, With resisted dorsiflexion and inversion of the foot, the distal tendon of the tibialis
anterior is usually easily visible. B, The belly of the right tibialis anterior is palpated.
TREATMENT CONSIDERATIONS 11
Q The tibialis anterior has a Q When the tibialis anterior
very prominent distal is tight and painful,
tendon. especially along its tibial
attachment, this condition
Q The tibialis anterior and is usually called shin
the fibularis longus are splints or anterior shin
known as the stirrup splints.
muscles. These two
muscles both attach at
the same location on the
medial foot and may be
viewed as a stirrup to
support the arch
structure of the foot.

Extensor Hallucis Longus
Pronunciation eks-TEN-sor hal-OO-sis LONG-us
The extensor hallucis longus is a long WHAT’S IN A NAME?

extensor of the big toe that is located in The name, extensor hallucis longus, tells us that this
the anterior compartment of the leg. Most muscle extends the big toe and is longer than the
extensor hallucis brevis.
of its belly is deep to the tibialis anterior
Derivation:
and extensor digitorum longus, but its extensor: L. muscle that extends a body part
distal tendon is superficial as it crosses the hallucis: L. refers to the big toe
ankle joint and on the dorsal surface of longus: L. longer
the foot (Figure 11-9).
ATTACHMENTS
11 Origin (Proximal Attachment)
Q Middle anterior fibula

Q Dorsal surface of the big toe (toe one)
ACTIONS
The extensor hallucis longus moves the foot at the
ankle and subtalar joints and the big toe at the meta-
O tarsophalangeal (MTP) and interphalangeal (IP) joints.
Extensor hallucis
longus Q Extends the big toe.
Q Dorsiflexes the foot (ankle joint).
Q Everts the foot (subtalar joint).
STABILIZATION
Stabilizes the ankle and subtalar joints and the MTP and
IP joints of the big toe.
INNERVATION
PALPATION
1. The client is supine. Place the fingers of the
I resistance hand on the dorsal surface of the distal
phalanx of the big toe.
2. Resist the client from extending the big toe at
FIGURE 11-9 Anterior view of the right extensor hallucis longus. the MTP and IP joints. Look for the tendon of the
extensor hallucis longus to become visible.
A B
FIGURE 11-10 Palpation of the right extensor hallucis longus as the client extends the big toe
against resistance. A, Palpation of the distal tendon on the dorsum of the foot. B, Palpation of the
belly in the anterolateral leg.
3. Palpate the distal tendon by strumming perpendicular

across it (Figure 11-10, A).
TREATMENT CONSIDERATION 11
4. Continue palpating the extensor hallucis longus Q When we swing forward
proximally. Once it goes deep to the adjacent during the gait cycle,
we usually extend our
musculature, do not strum perpendicular to it. Instead,
toes so they do not drag
gently place your finger pads over it, and feel for its on the ground.
contraction when the big toe extends (Figure 11-10, B).

Extensor Digitorum Longus
Pronunciation eks-TEN-sor dij-i-TOE-rum LONG-us
The extensor digitorum longus is a long WHAT’S IN A NAME?

extensor of toes two through five that is The name, extensor digitorum longus, tells us that
located in the anterior compartment of this muscle extends the digits (i.e., toes two through
five) and is longer than the extensor digitorum brevis.
the leg. Most of it is superficial except
Derivation:
for a small aspect of its proximal belly, extensor: L. muscle that extends a body part
which is deep to the tibialis anterior and digitorum: L. refers to a digit (toe)
fibularis longus (Figure 11-11). longus: L. longer
ATTACHMENTS
11 Origin (Proximal Attachment)
Q Proximal anterior fibula
O Insertion (Distal Attachment)

Q Dorsal surface of toes two through five
ACTIONS
The extensor digitorum longus moves the foot at the
Extensor ankle and subtalar joints and toes two through five
digitorum
longus at the metatarsophalangeal (MTP) and interphalangeal
(IP–proximal interphalangeal [PIP] and distal inter-
phalangeal [DIP] joints).
Q Extends toes two through five at the MTP and IP
joints.
Q Everts the foot at the subtalar joint.
STABILIZATION
Stabilizes the ankle and subtalar joints, and the MTP and
IP joints of toes two through five.
INNERVATION
I
PALPATION
FIGURE 11-11 Anterior view of the right extensor digitorum 1. The client is supine. Place your finger pads of the
longus. The fibularis tertius has been ghosted in. O, Origin; resistance hand on the dorsal surfaces of toes two to
I, insertion. five.
2. Resist the client from extending toes two to five at

the MTP and IP joints. Look for the tendons of the
extensor digitorum longus to become visible on the
dorsum of the foot.
3. Palpate the distal tendons by strumming
perpendicularly across them (Figure 11-12, A).
4. Continue palpating the extensor digitorum longus
proximally by strumming perpendicular to the fibers
(Figure 11-12, B).
A TREATMENT CONSIDERATIONS
Q The distal attachment of the extensor digitorum longus
spreads out to become a fibrous aponeurotic expansion
that covers much of the dorsal, medial, and lateral sides of
the toes. This structure is
called the dorsal digital
expansion (see page
391) and is an
attachment site for
many intrinsic foot 11
muscles.
Q The most distal and
lateral parts of the
extensor digitorum
B longus (which arises
from the distal one-
third of the fibula) does
FIGURE 11-12 The right extensor digitorum longus is palpated not attach onto the digits
as the client extends toes two to five against resistance. (toes); therefore it is given a
A, Palpation of the distal tendons on the dorsum of the foot. separate name, the fibularis tertius.
B, Palpation of the belly in the anterolateral leg.
MUSCLES OF THE LEG AND FOOT: Fibularis Group

Fibularis Longus; Fibularis Brevis; Fibularis Tertius
Pronunciation FIB YOU ,! RIS,/.' US s FIB YOU ,! RIS"2% VIS s FIB YOU ,! RIS4%2 SHE US
The fibularis group is located laterally on the leg, attached to the

fibula. It is composed of the fibularis longus, brevis, and tertius
(Figure 11-13). All three fibularis muscles evert the foot at the subtalar
joint. The fibularis longus and brevis are located in the lateral
compartment; the longus is superficial to the brevis; the fibularis
tertius is superficial and located in the anterior compartment. The
fibularis muscles used to be called the peroneus muscles.
11
O
O O
Fibularis longus Fibularis brevis Fibularis tertius
I
I
I
A B C
FIGURE 11-13 A, Lateral view of the right fibularis longus. B, Lateral view of the right fibularis
brevis. C, Anterior view of the right fibularis tertius. The extensor digitorum longus has been
WHAT’S IN A NAME?
The name, fibularis longus, tells us that this muscle Derivation:
attaches to the fibula and is longer than the fibularis fibularis: L. refers to the fibula
brevis. longus: L. longer
The name, fibularis brevis, tells us that this muscle brevis: L. shorter
attaches onto the fibula and is shorter than the tertius: L. third
fibularis longus.
The name, fibularis tertius, tells us that this muscle
attaches to the fibula and is the third fibularis muscle.
Fibularis Longus Fibularis Longus and Fibularis Brevis
Origin (Proximal Attachment) 1. The client is side lying. Place your palpating finger
pads on the lateral side of the fibula, just distal to the
Q Proximal lateral fibula
head of the fibula. Place the resistance hand on the
lateral side of the foot.
2. Resist the client from everting the foot at the subtalar
Q Medial foot
joint. Feel for the contraction of the fibularis longus
(Figure 11-14, A).
Fibularis Brevis 3. Continue palpating the fibularis longus distally by
strumming perpendicular to the fibers. The fibularis
Origin (Proximal Attachment) longus becomes tendon approximately halfway
Q Distal lateral fibula down the leg. The distal tendon can usually be seen
immediately posterior to the lateral malleolus of the
Insertion (Distal Attachment) fibula (Figure 11-14, B).
Q Fifth metatarsal 4. To palpate the fibularis brevis, palpate on either side
of the fibularis longus in the distal half of the leg
(Figure 11-15, A).
Fibularis Tertius 11
5. The distal tendon of the fibularis brevis is often visible
Origin (Proximal Attachment) and palpable in the proximal foot distal to the lateral
malleolus of the fibula (Figure 11-15, B).
Q Distal anterior fibula

Q Fifth metatarsal
ACTIONS
Fibularis Longus and Fibularis Brevis
Q Evert the foot at the subtalar joint.
Q Plantarflex the foot at the ankle joint.
A
Fibularis Tertius
Q Everts the foot at the subtalar joint.
STABILIZATION
Stabilize the ankle and subtalar joints.
INNERVATION
Q Superficial fibular nerve (longus and brevis) B
Q Deep fibular nerve (tertius)
FIGURE 11-14 A, The belly of the fibularis longus is palpated as
the client everts the foot against resistance. B, When resistance is
applied to eversion of the foot, the distal tendon of the fibularis
longus is often visible just proximal to the lateral malleolus of the
fibula.
Turn page to 'more.

Fibularis
brevis
A Fibularis longus tendon B
FIGURE 11-15 The right fibularis brevis is palpated as the client everts the foot against resistance.
A, The fibularis brevis belly is palpated immediately posterior to the fibularis longus tendon. B, Its
distal tendon is palpated distal to the lateral malleolus.
11
Q The distal tendon of the fibularis longus follows an unusual
path; it crosses posterior to the lateral malleolus to enter
the lateral side of the foot, where it crosses posterior to
the cuboid and then dives deep into the plantar side of the
foot. It finally attaches onto the medial side of the foot at the
same location as the attachment of the tibialis anterior (first
cuneiform and first metatarsal).
Q The fibularis longus and the
tibialis anterior are known
as the stirrup muscles.
These two muscles both
attach at the same
location on the medial
FIGURE 11-16 Anterolateral view of the right fibularis tertius foot and may be viewed
demonstrates palpation of the distal tendon of the fibularis to act as a stirrup to sup-
tertius as the client everts and dorsiflexes the foot against port the arch structure of the foot.
resistance. The extensor digitorum longus has been ghosted in. Q The fibularis longus and the fibularis
brevis should be strengthened in
people who have had inversion
sprains of the ankle joint.
Fibularis Tertius Q The fibularis tertius is actually the most distal and lateral part
of the extensor digitorum longus. Its
1. To palpate the fibularis tertius, find the distal tendon fibers do not attach onto I think
of the extensor digitorum longus on the dorsum a digit (a phalanx); it’s missing!
of the foot that goes to the little toe; then palpate for this reason the
directly lateral to it, feeling for a tendon that goes to fibularis tertius is
the fifth metatarsal. It may not be visible; therefore given a separate
name and considered
you may need to strum perpendicular to its fiber
to be a separate
direction to feel for it; it may even be necessary to muscle from the
gently use a fingernail to feel it. extensor digitorum
2. If the fibularis tertius is not readily palpable, then longus.
resist the client from everting and dorsiflexing the Q The fibularis tertius
foot and palpate again for its tendon (Figure 11-16). is sometimes missing.
Notes
MUSCLES OF THE LEG AND FOOT: Triceps Surae Group

Gastrocnemius; Soleus
Pronunciation '!3 TROK .%% ME US s 3/ LEE US
The triceps surae group of the

superficial posterior compart-
ment of the leg is composed of
O
the soleus and the two heads
(medial and lateral) of the
gastrocnemius (Figure 11-17).
O The gastrocnemius and soleus
are grouped together as the tri-
ceps surae because they attach
together onto the calcaneus via
the calcaneal (Achilles) tendon.
11 From the posterior perspective,
Soleus the gastrocnemius is superfi-
cial to the soleus. However, the
soleus is superficial in the lat-
eral and medial leg.
I I
A B
FIGURE 11-17 A, Posterior view of the right gastrocnemius, B, Posterior view

of the right soleus. O, Origin; I, insertion.
WHAT’S IN A NAME?
The name, gastrocnemius, tells us that this muscle Derivation:
gives the posterior leg its belly shape. (The contour of gastro: Gr. stomach
the posterior leg is the result of the two bellies of the nemius: Gr. leg
gastrocnemius.) soleus: L. sole of the foot
The name, soleus, tells us that this muscle
attaches onto the sole (calcaneus) of the foot.
ATTACHMENTS
Gastrocnemius
Q Medial and lateral femoral condyles

Q Calcaneus via the calcaneal (Achilles) tendon
Soleus A
Q Posterior tibia and fibula

Q Calcaneus via the calcaneal (Achilles) tendon
11
ACTIONS
Q Plantarflex the foot at the ankle joint (gastrocnemius
and the soleus)
Q Flexes the leg at the knee joint (gastrocnemius only) B
STABILIZATION FIGURE 11-18 Palpation of the right gastrocnemius as the client

plantarflexes the foot against resistance. A, Palpation of the
Both the gastrocnemius and the soleus stabilize the ankle medial belly. B, Palpation of the calcaneal (Achilles) tendon with
and subtalar joints. The gastrocnemius also stabilizes the two fingers on either side of the tendon just proximal to the
knee joint. calcaneus.
INNERVATION
Q Tibial nerve Soleus
1. The client is prone with the knee joint flexed to
approximately 90 degrees. Place your palpating
PALPATION finger pads on the proximal posterior leg. Place the
resistance hand on the plantar surface of the foot.
Gastrocnemius 2. Ask the client to plantarflex the foot against gentle
1. The client is prone with the knee joint fully or nearly resistance. Feel for the contraction of the soleus deep
fully extended. Place your palpating finger pads on to (through) the gastrocnemius (Figure 11-19, A).
the proximal posterior leg. Place the resistance hand 3. Palpate the soleus to its proximal attachment, and
on the plantar surface of the foot. palpate it distally to its distal attachment on the
2. Ask the client to plantarflex the foot against your posterior calcaneus via the Achilles tendon.
resistance. Feel for the contraction of the gastroc- 4. The soleus is superficial and can be palpated in the
nemius (Figure 11-18, A). Palpate the medial and lateral leg (Figure 11-19, B).
lateral bellies of the gastrocnemius in the proximal
posterior leg. Note: A portion of the soleus is also superficial and can also
be palpated on the medial side of the proximal leg.
3. Approximately halfway down the leg, the gastroc-
nemius becomes tendon. Palpate the tendon all the
way to its attachment on the posterior surface of the
calcaneus via the Achilles tendon (Figure 11-18, B).
Turn page to 'more.

11 A B
FIGURE 11-19 Palpation of the right soleus as the client plantarflexes the foot against gentle
resistance with the knee joint flexed. A, Palpation of the posterior aspect through the
gastrocnemius. B, Palpation of the lateral aspect where the soleus is superficial.
Q The Achilles tendon Q Excessive use of high-
derives its name from heeled shoes can result
the Greek myth in in chronically shortened
which Achilles went triceps surae muscles.
into battle to rescue
Helen of Troy. When he Q The gastrocnemius
was young, to make and soleus muscles
him invulnerable to are both stretched by
poison arrows, his dorsiflexing the ankle
mother dipped him into joint. Keeping the
the River Styx. However, knee joint extended
she held him by his preferentially stretches
posterior ankle (i.e., heel). the gastrocnemius;
Therefore he was vulnerable in flexing the knee joint
that one spot; hence, the expression Achilles’ heel denotes preferentially stretches
a person’s weakness. Unfortunately, Paris hit him with a the soleus.
Gastrocnemius
poison arrow in his heel and he died. The relevance to
Q The soleus is a
anatomy is that if the Achilles tendon ruptures, an individual
thick muscle, largely
loses the ability to walk and/or run, which makes him or her
accounting for the
vulnerable and weak. Soleus
contours of the
gastrocnemius
being so visible. (“Behind
every great gastrocnemius
is a great soleus.” - )
Notes

Plantaris
Pronunciation plan-TA-ris
The plantaris is a small muscle in the WHAT’S IN A NAME?

superficial posterior compartment of The name, plantaris, tells us that this muscle attaches
the leg. It has a very small belly with an onto the calcaneus, a bone of the plantar surface of
the foot.
extremely long tendon (Figure 11-20).
Derivation:
Most of the plantaris is deep to the plantaris: L. refers to the plantar side of the foot
soleus.
ATTACHMENTS
O
11 Q Distal posterolateral femur
Plantaris
Q Calcaneus
ACTIONS
Q Plantarflexes the foot at the ankle joint.
Q Flexes the leg at the knee joint.
STABILIZATION
Stabilizes the ankle, subtalar, and knee joints.
INNERVATION
Q Tibial nerve
I
PALPATION
1. To palpate the plantaris, begin with gentle palpation in
the center of the popliteal fossa and gradually move
laterally until you feel the presence of the muscle
tissue that contracts with plantarflexion of the foot
at the ankle joint (Figure 11-21). You are now on the
plantaris. Discerning the plantaris from the lateral
head of the gastrocnemius is difficult because these
two muscles have identical actions.
FIGURE 11-20 Posterior view of the right plantaris. The popliteus
has been ghosted in. O, Origin; I, insertion.
Q The name plantaris is misleading, because this muscle does
not attach onto the plantar surface of the foot in humans
(although it does attach onto the posterior calcaneus, which
is near the plantar surface). In other primates, the plantaris
curves around the calcaneus to attach into the plantar
fascia, thereby actually attaching onto the plantar surface of
the foot.
Q The distal tendon of the plantaris muscle also attaches into
the calcaneus, next to the Achilles tendon. Some sources
group the two heads of the gastrocnemius, the soleus, and
the plantaris as the quadriceps surae group.
FIGURE 11-21 Palpation of the plantaris as the client

plantarflexes the foot against resistance.
11
MUSCLES OF THE LEG AND FOOT:

Tom, Dick, and Harry Group
Tibialis Posterior; Flexor Digitorum Longus; Flexor Hallucis Longus
Pronunciation TIB EE ! LISPOS 4%% RI OR s &,%+3 ORDIJ I 4/% RUM,/.' US s
&,%+3 ORHAL // SIS,/.' US
The Tom, Dick, and Harry group is located in the deep posterior
compartment of the leg and is composed of the tibialis posterior,
flexor digitorum longus, and flexor hallucis longus (Figure 11-22).
Posteriorly, they are deep to the soleus, but they do have some
superficial exposure in the distal medial leg. They are grouped
together because all of their distal tendons cross posterior and
distal to the medial malleolus of the tibia; therefore they all
perform inversion and plantarflexion of the foot.
11
O
O
Tibialis posterior

I I
A B C
FIGURE 11-22 A, Posterior view of the right tibialis posterior. B, Posterior view of the right flexor
digitorum longus. The flexor hallucis longus has been ghosted in. C, Posterior view of the right
flexor hallucis longus. The flexor digitorum longus has been ghosted in. O, Origin; I, insertion.
WHAT’S IN A NAME? interphalangeal [DIP] joints). The flexor hallucis longus

also moves the big toe (toe one) at the IP joint.
The name, tibialis posterior, tells us that this muscle
attaches to the tibia and is located in the posterior leg.
The name, flexor digitorum longus, tells us that this Tibialis Posterior
muscle flexes the digits (toes) and is longer than the Q Plantarflexes the foot.
flexor digitorum brevis. Q Inverts the foot.
The name, flexor hallucis longus, tells us that this
muscle flexes the big toe and is longer than the flexor
hallucis brevis. Flexor Digitorum Longus
Derivation: Q Flexes toes two through five at the MTP and IP joints.
tibialis: L. refers to the tibia Q Plantarflexes the foot.
posterior: L. behind, toward the back
flexor: L. muscle that flexes a body part Q Inverts the foot.
digitorum: L. refers to a digit (toe)
hallucis: L. big toe
longus: L. longer
Q Flexes the big toe at the MTP and IP joints.
Q Plantarflexes the foot.
Q Inverts the foot.
11
ATTACHMENTS
STABILIZATION
Tibialis Posterior Q All three stabilize the ankle and subtalar joints.
Origin (Proximal Attachment) Q The flexor digitorum longus and flexor hallucis longus
Q Posterior tibia and fibula also stabilize the MTP and IP joints of the toes.

Q Navicular tuberosity INNERVATION
Q Tibial nerve
Flexor Digitorum Longus
Q Middle posterior tibia PALPATION
Insertion (Distal Attachment) Tibialis Posterior
Q Plantar surface of toes two through five 1. The client is prone with a roll under the ankles. If
resistance is needed, place your resistance hand on
the foot.
2. Ask the client to plantarflex the foot at the ankle joint
Origin (Proximal Attachment) and invert the foot at the subtalar joint. Look for the
Q Distal posterior fibula distal tendon of the tibialis posterior immediately
posterior and distal to the medial malleolus of the
Insertion (Distal Attachment) tibia. If needed, resistance can be added (Figure
Q Plantar surface of the big toe (toe one) 11-23, A).
3. Once located, strum perpendicularly across the
tendon as the client alternately contracts and relaxes
the muscle. Palpate the tendon distally as far as
ACTIONS possible.
All three muscles of this group plantarflex the foot at the 4. The belly of the tibialis posterior is located very deep
ankle joint and invert the foot at the subtalar joint. The in the posterior compartment of the leg. Gently press
flexor digitorum longus also moves toes two through over the belly in the midline of the posterior leg, and
five at the metatarsophalangeal (MTP) and interphalan- ask the client to invert the foot. Feel for its contraction
geal (IP–proximal interphalangeal [PIP] and distal (Figure 11-23, B).
Turn page to 'more.

A B
FIGURE 11-23 Palpation of the tibialis posterior as the client plantarflexes and inverts the foot
against resistance. A, Visualization of the distal tendon near the medial malleolus. B, Palpation
proximally of the belly deep to the gastrocnemius and soleus. Note: The gastrocnemius and
soleus have been ghosted in both A and B.
11
FIGURE 11-24 Palpation of the flexor digi-

torum longus as the client flexes toes two
to five against resistance. A, Palpation of
the belly in the distal medial leg. B, Pal-
pation of the distal tendons in the plan-
tar foot. C, Palpation proximally of the
belly deep in the posterior leg. Note: The
gastrocnemius and soleus have been
C ghosted in parts A and C.
Flexor Digitorum Longus and the shaft of the tibia (see Figure 11-3, B). Ask the
client to flex toes two to five; feel for its contraction
1. The client is prone with a roll under the ankles. If (Figure 11-24, A). If needed, resistance can be added.
resistance is needed, place your resistance fingers on 3. Within the plantar foot, the distal tendons of the flexor
toes two through five. digitorum longus are fairly superficial and can usually
2. Part of the belly of the flexor digitorum longus is be palpated if the client alternately contracts and
superficial in the distal medial leg between the soleus relaxes the muscle (Figure 11-24, B).
FIGURE 11-25 Palpation of the flexor hallu-

cis longus as the client flexes the big toe 11
against resistance. A, Palpation of the belly
in the distal medial leg. B, Palpation of the
distal tendon in the plantar foot. C, Palpation
proximally of the belly deep in the posterior
leg. Note: The gastrocnemius and soleus
C have been ghosted in parts A and C.
4. The belly of the flexor digitorum longus is located TREATMENT CONSIDERATIONS

deep in the posterior compartment of the leg. To
palpate its belly, press gently over it in the posterior Q It is worth noting that the location of the muscle bellies of the
medial leg, ask the client to flex toes two to five. Feel Tom, Dick, and Harry muscles in the posterior leg is, from
medial to lateral, Dick, Tom, and Harry (i.e., flexor digitorum
for its contraction (Figure 11-24, C).
longus, tibialis posterior, and flexor hallucis longus).
Q The tibialis posterior plays an
Flexor Hallucis Longus important role in supporting and
stabilizing the arch structure of the
1. A small part of the distal belly of the flexor hallucis
foot. Because the tibialis posterior
longus is superficial in the distal medial leg between helps support the arch (medial
the flexor digitorum longus and the calcaneal tendon longitudinal arch) of the foot, some
(see Figure 11-3, B). Ask the client to flex the big toe. sources consider it to be the
Feel for its contraction (Figure 11-25, A). If needed, medial stirrup muscle, instead
resistance can be added. of the tibialis anterior.
2. Once the flexor hallucis longus has been found, Q When the tibialis posterior
strum perpendicular to its fibers and try to follow it is tight and painful, this
as far distally as possible. At the level of the medial condition is often called
shin splints or posterior
malleolus, its distal tendon runs quite deep and is
shin splints.
difficult to palpate.
Q For the tendons of the flexor digitorum longus to reach their
3. Within the plantar foot, the distal tendon of the flexor
insertion (distal attachment) on the toes, the tendons of the
hallucis longus is fairly superficial and can usually be
flexor digitorum brevis split, and the tendons of the flexor
palpated if the client alternately contracts and relaxes digitorum longus then pass through these splits to continue
the muscle by flexing the big toe (Figure 11-25, B). on to the distal phalanges.)
4. The belly of the flexor hallucis longus is located deep in Q Because the four individual distal tendons of the flexor
the posterior compartment of the leg. Gently press over digitorum longus split from one common distal tendon, the
it in the posterior lateral leg, and ask the client to flex flexor digitorum longus does not allow for individual control
the big toe. Feel for its contraction (Figure 11-25, C). of toes two through five.

Popliteus
Pronunciation pop-LIT-ee-us
The popliteus is located in the deep

WHAT’S IN A NAME?
posterior compartment of the leg, deep The name, popliteus, tells us that this muscle is
to the gastrocnemius and proximal located in the posterior knee.
Derivation:
to the soleus. It crosses the knee joint
popliteus: L. ham of the knee (refers to the posterior
from lateral on the femur to medial on knee)
the tibia (Figure 11-26).
ATTACHMENTS
Q Distal posterolateral femur
11 Insertion (Distal Attachment)

O
Q Proximal posteromedial tibia
Popliteus
I ACTIONS
The popliteus moves the leg or the thigh at the knee
joint.
Q Medially rotates the leg.
Q Flexes the leg.
Q Laterally rotates the thigh (at the knee joint).
STABILIZATION
Stabilizes the knee joint.
INNERVATION
Q Tibial nerve
PALPATION
1. The client is prone with the leg flexed 90 degrees at
the knee joint. Curl your palpating finger pads around
the posterior side of the medial border of the proximal
tibia. If resistance is given, place the resistance hand
on the distal leg (just proximal to the ankle joint).
2. Ask the client to medially rotate the leg at the knee
joint. Feel for the contraction of the popliteus.
Resistance can be given if desired (Figure 11-27).
FIGURE 11-26 Posterior view of the right popliteus. The soleus

3. Once the tibial attachment of the popliteus has been
has been ghosted in. O, Origin; I, insertion. felt, try to continue palpating the popliteus through
the gastrocnemius toward its proximal attachment
while the client is alternately contracting and relaxing
it by medially rotating the leg at the knee joint.
Q The popliteus also attaches
into the lateral meniscus
of the knee joint. This
attachment helps prevent
impingement of the
lateral meniscus
between the femur
and tibia during
flexion of the knee joint.
11
FIGURE 11-27 Palpation of the tibial attachment of the popliteus

as the client medially rotates the leg against resistance.

Intrinsic Foot—Dorsal Surface
Extensor Digitorum Brevis; Extensor Hallucis Brevis
Pronunciation EKS 4%. SORDIJ I 4/% RUM"2% VIS s EKS 4%. SORHAL // SIS"2% VIS
The extensor digitorum brevis and extensor hallucis brevis are

two intrinsic foot muscles of the dorsal surface of the foot (Figure
11-28). Except for the distal tendons of the extensor digitorum
longus and fibularis tertius, they are superficial.
O O
11
Extensor hallucis brevis
A B
FIGURE 11-28 A, Dorsal view of the right extensor digitorum brevis. The extensor hallucis brevis
has been ghosted in. B, Dorsal view of the right extensor hallucis brevis. The extensor digitorum
brevis has been ghosted in. O, Origin; I, insertion.

The name, extensor digitorum brevis, tells us that this Extensor Digitorum Brevis
muscle extends the digits (i.e., toes) and is shorter
than the extensor digitorum longus. Origin (Proximal Attachment)
The name, extensor hallucis brevis, tells us that Q Dorsal surface of the calcaneus
this muscle extends the big toe and is shorter than
the extensor hallucis longus. Insertion (Distal Attachment)
Derivation: Q Toes two through four
extensor: L. muscle that extends a body part
digitorum: L. refers to a digit (toe)
hallucis: L. refers to the big toe
brevis: L. shorter

Q Dorsal surface of the calcaneus

Q Dorsal surface of the big toe (toe one)
ACTIONS
The extensors digitorum and hallucis brevis move
the toes at the metatarsophalangeal (MTP) and/or
the proximal interphalangeal (PIP) and distal inter-
phalangeal (DIP) joints.
A
Extensor Digitorum Brevis
Q Extends toes two through four at the MTP, PIP, and
DIP joints.
11
Q Extends the big toe at the MTP joint.
STABILIZATION
Stabilizes the MTP, PIP, and DIP joints of the toes.
INNERVATION
B
FIGURE 11-29 Palpation of the right extensor digitorum brevis

PALPATION (EDB) and extensor hallucis brevis (EHB). A, Palpation of the
1. The client is supine. First visualize the common belly in EDB as the client extends toes two to four against resistance.
The EHB has been ghosted in. B, Palpation of the EHB as the
the proximal dorsolateral surface of the foot (approxi-
client extends the big toe against resistance. The EDB has been
mately 1 inch distal to the lateral malleolus of the fibula). ghosted in.
2. Extensor digitorum brevis: Once visualized, place
your palpating finger pads on the belly and place
the fingers of the resistance hand on the proximal
phalanges of toes two to four. TREATMENT CONSIDERATIONS
3. Resist the client from extending toes two to four; look
Q The extensor digitorum
for and then palpate the contraction of the belly of the brevis and extensor hallucis
extensor digitorum brevis (Figure 11-29, A). brevis are actually one
4. Extensor hallucis brevis: Now move the finger pads of muscle. However, they are
the resistance hand onto the proximal phalanx of the separately named based
on their distal attachments.
big toe. Resist the client from extending the big toe;
Digitorum attaches to toes
look for and then palpate the contraction of the belly two through four; hallucis
of the extensor hallucis brevis (Figure 11-29, B). attaches to the big toe (toe one).
5. Ask the client to alternately contract and relax the exten- Q The common belly of the
sors digitorum and hallucis brevis against resistance; extensors digitorum and
try to follow each one distally toward its toe attachment hallucis brevis is often visible on
by strumming perpendicularly to the tendon(s). the proximal lateral surface of the dorsum of the foot.

Intrinsic Foot—Plantar Layer I
Abductor Hallucis; Abductor Digiti Minimi Pedis;
Pronunciation AB $5+ TORHAL // SIS s AB $5+ TOR$)* I TEE-). I MEE0%%$ US s
&,%+3 ORDIJ I 4/% RUM"2% VIS
Layer I of the plantar surface of the foot contains three muscles:

the abductor hallucis on the big toe side, the abductor digiti
minimi pedis on the little toe side, and the flexor digitorum
brevis in between (Figure 11-30). They all originate on (attach
proximally to) the tuberosity of the calcaneus and are superficial,
except for being deep to the plantar fascia of the foot.
11 I
Flexor
digitorum
Abductor brevis
hallucis
Abductor digiti
minimi pedis
O O O
A B C
FIGURE 11-30 Plantar views of the intrinsic muscles of the right foot, Plantar Layer I. A, Abductor
hallucis. B, Abductor digiti minimi pedis. C, Flexor digitorum brevis. O, Origin; I, insertion.
WHAT’S IN A NAME? Abductor Hallucis

The name, abductor hallucis, tells us that this muscle
Q Abducts the big toe at the MTP joint.
abducts the big toe.
The name, abductor digiti minimi pedis, tells us Abductor Digiti Minimi Pedis
that this muscle abducts the little toe.
Q Abducts the little toe at the MTP joint.
The name, flexor digitorum brevis, tells us that this
muscle flexes the digits (i.e., toes) and is shorter than
the flexor digitorum longus. Flexor Digitorum Brevis
Derivation: Q Flexes toes two through five at the MTP and PIP
abductor: L. muscle that abducts a body part joints.
hallucis: L. refers to the big toe
digitorum, digiti: L. refers to a digit (toe)
STABILIZATION
minimi: L. least
pedis: L. refers to the foot Q The abductor hallucis and abductor digiti minimi
flexor: L. muscle that flexes a body part pedis stabilize the MTP joints of the big and little toes,
brevis: L. shorter respectively.
Q The flexor digitorum brevis stabilizes the MTP and PIP
joints of toes two through five.
11
ATTACHMENTS
INNERVATION
Abductor Hallucis Q Medial plantar nerve (abductor hallucis and flexor
Origin (Proximal Attachment) digitorum brevis)
Q Tuberosity of the calcaneus Q Lateral plantar nerve (abductor digiti minimi pedis)

Q Big toe (toe one) PALPATION
For all three palpations, have the client prone with a roll
Abductor Digiti Minimi Pedis under the ankles.

Q Tuberosity of the calcaneus
Abductor Hallucis
1. Place your palpating finger pads on the medial side of
Insertion (Distal Attachment) the foot, close to the plantar surface.
Q Little toe (toe five) 2. Ask the client to abduct the big toe at the MTP joint.
Feel for the contraction of the abductor hallucis. If
desired, resistance can be given by placing a finger
Flexor Digitorum Brevis of the resistance hand on the medial side of the
proximal phalanx of the big toe (Figure 11-31).
3. Once located, palpate the abductor hallucis
Q Tuberosity of the calcaneus proximally and distally toward its attachments by
strumming perpendicular to its fibers.
Q Toes two through five
Abductor Digiti Minimi Pedis
1. Move your palpating finger pads over to the lateral
side of the distal foot, close to the plantar surface.
ACTIONS
2. Ask the client to abduct the little toe at the MTP joint;
All three muscles of plantar layer I move the toes at the feel for the contraction of the abductor digiti minimi
metatarsophalangeal (MTP) and/or proximal inter- pedis. If desired, resistance can be given by placing a
phalangeal (PIP) joints. finger of the resistance hand on the lateral side of the
proximal phalanx of the little toe (Figure 11-32).
Turn page to 'more.

11
FIGURE 11-31 Palpation of the right abductor hallucis as the FIGURE 11-33 Palpation of the right flexor digitorum brevis as
client abducts the big toe against resistance. the client flexes toes two to five against resistance.
3. Once located, palpate the flexor hallucis brevis

proximally and distally toward its attachments by
strumming perpendicular to its fibers.

1. Move your palpating finger pads to the midline of the
plantar surface of the proximal foot.
2. Ask the client to flex toes two through five at the MTP
joints; feel for the contraction of the flexor digitorum
brevis. If desired, resistance can be given with the
finger pads of the resistance hand on the plantar
surface of the proximal or middle phalanges of toes
two to five (Figure 11-33).
3. Once located, palpate the flexor digitorum
brevis proximally to the calcaneus by strumming
perpendicular to its fibers. Then palpate it distally as
far as possible.
FIGURE 11-32 Palpation of the right abductor digiti minimi pedis

as the client abducts the little toe against resistance.
Q In addition to their bony Q Each distal tendon of the flexor digitorum brevis splits to
attachments, all three allow passage for the flexor digitorum longus’ distal tendon
muscles in the first to attach onto the distal phalanx of toes two through five.
plantar layer of intrinsic
muscles of the foot also
attach into the plantar
fascia of the foot.
Therefore strengthening
these muscles can help
stabilize the plantar
fascia and therefore
the arch structure of
the foot.
11

Intrinsic Foot—Plantar Layer II
Quadratus Plantae; Lumbricals Pedis
Pronunciation KWOD 2!9 TUS0,!. TEE s ,5- BRI KULS0%%$ US
Layer II of the plantar surface of the foot contains one muscle,

the quadratus plantae; and one muscle group, the lumbricals
pedis group, which is composed of four lumbricals pedis muscles,
named one, two, three, and four from medial to lateral (Figure
11-34). The quadratus plantae and lumbricals pedis muscles are
located midline in the plantar foot and attach into the distal
tendon of the flexor digitorum longus. The quadratus plantae is
entirely deep to the flexor digitorum brevis; the lumbricals pedis
muscles are partially deep to the flexor digitorum brevis.
11
Lumbricals pedis
I
O
Distal tendon of flexor
digitorum longus
Quadratus plantae
A B
FIGURE 11-34 A, Plantar view of the right quadratus plantae. B, Plantar view of the right
lumbricals pedis. The quadratus plantae has been ghosted in. O, Origin; I, insertion.

Plantar layer II muscles stabilize the MTP, PIP, and DIP
The name, quadratus plantae, tells us that this
joints of toes two through five.
muscle has a square shape and is located on the
plantar side of the foot.
The name, lumbricals pedis, tells us that these
muscles are shaped like earthworms and are located INNERVATION
in the foot. (The four lumbrical pedis muscles are
named one, two, three, and four.) Q Lateral plantar nerve (quadratus plantae)
Derivation: Q Medial and lateral plantar nerves (lumbricals pedis)
plantae: L. refers to the plantar surface of the foot
lumbricals: L. earthworms PALPATION
pedis: L. refers to the foot
Quadratus Plantae
1. The client is supine. Place your palpating finger pads
on the midline of the plantar surface of the proximal
foot.
ATTACHMENTS 2. Ask the client to flex toes two to five; feel for the
Quadratus Plantae contraction of the quadratus plantae. Because the 11
quadratus plantae lies immediately deep to the flexor
Origin (Proximal Attachment) digitorum brevis and both these muscles flex toes
Q Calcaneus two to five, palpating and discerning the quadratus
plantae from the flexor digitorum brevis can be very
Insertion (Distal Attachment) difficult.
Q Distal tendon of the flexor digitorum longus muscle
Lumbricals pedis
Lumbricals Pedis 1. Now place your palpating finger pads between the
metatarsal bones on the plantar surface of the foot.
Origin (Proximal Attachment) Ask the client to flex toes two to five at the MTP joints
Q Distal tendons of the flexor digitorum longus muscle and, if possible, keep the IP joints extended; feel for
their contraction.
Q Dorsal digital expansion
Q The quadratus plantae
ACTIONS assists the flexor
digitorum longus by
The quadratus plantae and lumbricals pedis move toes both adding strength
two through five at the metatarsophalangeal (MTP), to the contraction
proximal interphalangeal (PIP), and distal inter- and also by
phalangeal (DIP) joints. straightening out its
line of pull. Because
the flexor digitorum
Quadratus Plantae longus enters the foot
from the medial side,
Q Flexes toes two through five at the MTP, PIP, and DIP it tends to pull the
joints. toes toward that side
when it contracts.
The quadratus plantae straightens out this line of pull to
Lumbricals Pedis keep the toes straight when they flex.
Q Flex toes two through five at the MTP joints.

Q Extend toes two through five at the PIP and DIP joints.

Intrinsic Foot—Plantar Layer III
Flexor Hallucis Brevis; Flexor Digiti Minimi Pedis; Adductor Hallucis
Pronunciation &,%+3 ORHAL // SIS"2% VIS s &,%+3 OR$)* I TEE-). I MEE0%%$ US s
AD $5+ TORHAL // SIS
Layer III of the plantar surface of the foot contains three muscles:
the flexor hallucis brevis on the big toe side, the flexor digiti
minimi pedis on the little toe side, and the adductor hallucis
in between. The adductor hallucis has transverse and oblique
heads (Figure 11-35). Although they are in the third plantar layer,
much of the flexor hallucis brevis, flexor digiti minimi pedis,
and transverse head of the adductor hallucis are deep only to the
plantar fascia.
11 Plantar
metatarsophalangeal
ligaments
Transverse
I
I head
I
Oblique
head O
Flexor
digiti
minimi
pedis
Distal tendon
O O of fibularis
longus
Distal
tendon
of fibularis
longus
A B C
FIGURE 11-35 Plantar views of the intrinsic muscles of the right foot, Plantar Layer II. A, Flexor
hallucis brevis. B, Flexor digiti minimi pedis. C, Adductor hallucis. O, Origin; I, insertion.
WHAT’S IN A NAME? Flexor Hallucis Brevis

The name, flexor hallucis brevis, tells us that this
Q Flexes the big toe at the MTP joint.
muscle flexes the big toe and is shorter than the
flexor hallucis longus.
The name, flexor digiti minimi pedis, tells us that
Flexor Digiti Minimi Pedis
this muscle flexes the little toe. Q Flexes the little toe at the MTP joint.
The name, adductor hallucis, tells us that this
muscle adducts the big toe.
Derivation: Adductor Hallucis
flexor: L. muscle that flexes a body part Q Adducts the big toe at the MTP joint.
adductor: L. muscle that adducts a body part
hallucis: L. refers to the big toe STABILIZATION
digiti: L. refers to a digit (toe)
brevis: L. shorter Stabilizes the MTP joints of the big and little toes.
minimi: L. least
pedis: L. refers to the foot
INNERVATION
Q Medial plantar nerve (flexor hallucis brevis)
11
ATTACHMENTS Q Lateral plantar nerve (flexor digiti minimi pedis and
adductor hallucis)
Q Cuboid and the third cuneiform
PALPATION
To palpate all three muscles of the third plantar layer,
Insertion (Distal Attachment) have the client prone with a roll under the ankles.
Q Big toe (toe one)
Flexor Digiti Minimi Pedis 1. Place your palpating finger pads over the first meta-
tarsal bone on the plantar side of the foot.
Origin (Proximal Attachment) 2. Now ask the client to flex the big toe at the MTP joint;
Q Fifth metatarsal feel for the contraction of the flexor hallucis brevis.
If desired, resistance can be given with the fingers
Insertion (Distal Attachment) of the resistance hand on the plantar surface of the
Q Little toe (toe five) proximal phalanx of the big toe (Figure 11-36).
3. Once located, palpate it proximally and distally to its
attachments by strumming perpendicular to its fibers.
Adductor Hallucis
Origin (Proximal Attachment) Flexor Digiti Minimi Pedis
Q Metatarsals
1. Move your palpating finger pads over the fifth
metatarsal bone on the plantar side of the foot.
Q Big toe (toe one) 2. Ask the client to flex the little toe at the MTP joint;
feel for the contraction of the flexor digiti minimi pedis.
If desired, resistance can be given with a finger of the
resistance hand on the plantar surface of the proximal
ACTIONS phalanx of the little toe (Figure 11-37).
The flexor hallucis brevis, flexor digiti minimi pedis, 3. Once located, palpate it distally to the proximal
and adductor hallucis move the toes at the metatar- phalanx of the little toe by strumming perpendicular to
sophalangeal (MTP) joints. its fibers. Then palpate it proximally as far as possible.
Turn page to 'more.

11
FIGURE 11-36 Palpation of the right flexor hallucis brevis as the FIGURE 11-37 Palpation of the right flexor digiti minimi pedis as
client flexes the big toe against resistance. the client flexes the little toe against resistance.
Adductor Hallucis TREATMENT CONSIDERATIONS

1. Place your palpating finger pads over the heads of Q A sesamoid bone is located distally in each of the medial
the metatarsals of the second, third, and fourth toes. and lateral tendons of the flexor hallucis brevis.
Place the fingers of resistance hand on the lateral side
Q The adductor hallucis occasionally
of the proximal phalanx of the big toe.
has attachments onto the first
2. Ask the client to adduct the big toe against metatarsal distally and can
resistance; feel for the contraction of the transverse oppose the big toe toward
head of the adductor hallucis. Try to palpate the the other toes. When this
oblique head in a similar manner. occurs, it is named the
opponens hallucis of the
Note: This muscle can be challenging to palpate and discern. foot. The flexor digiti
minimi pedis occasionally
has attachments onto the
fifth metatarsal distally
and can oppose the little toe.
When this occurs, it is named the opponens digiti minimi
pedis. These muscles are commonly found in apes, who
have feet that are more handy than ours!
Q The adductor hallucis stabilizes the arch structure of the foot.
Notes

Intrinsic Foot—Plantar Layer IV
Plantar Interossei; Dorsal Interossei Pedis
Pronunciation 0,!. TARIN TER /33 EE EYE s $/2 SULIN TER /33 EE EYE0%%$ US
Layer IV of the plantar surface of the foot contains two muscle

groups: the plantar interossei and the dorsal interossei pedis.
Three plantar interossei attach to toes three through five; they
are named one, two, and three from the medial side. Four dorsal
interossei pedis attach to toes two through four; they are named
one, two, three, and four from the medial side (Figure 11-38). The
plantar interossei are very deep in the plantar foot. Although the
dorsal interossei pedis are considered plantar muscles, they are
accessible to palpation on the dorsal side of the foot.
11
O O
A B
FIGURE 11-38 A, Plantar view of the right plantar interossei. B, Dorsal view of the right dorsal
interossei pedis. O, Origin; I, insertion.

Stabilize toes two through five.
The name, plantar interossei, tells us that these
muscles are located between bones (metatarsals) on
the plantar side.
The name, dorsal interossei pedis, tells us that
INNERVATION
these muscles are located between bones (metatar- Q Lateral plantar nerve
sals) on the dorsal side and located in the foot.
Derivation:
plantar: L. refers to the plantar side of the foot PALPATION
dorsal: L. refers to the dorsal side
interossei: L. between bones Plantar Interossei
pedis: L. refers to the foot 1. The client is prone with a roll under the ankles. Place
your palpating finger pads between metatarsals
(second through fifth) on the plantar side.
2. Resist the client from adducting toes three through
five; feel for the contraction of the plantar interossei.
ATTACHMENTS 3. Given their depth and the difficulty that most people
have isolating the action of this muscle group, the
Plantar Interossei plantar interossei are usually difficult to palpate and 11
discern from adjacent soft tissues.
Q Metatarsals
Insertion (Distal Attachment) 1. The client is supine. Place your palpating finger pads
Q Second-toe sides of the proximal phalanges of toes on the dorsal side of the foot between the metatarsal
three through five bones.
2. The first dorsal interosseus is palpated between the
first and second metatarsals (Figure 11-39, A).
Q Metatarsals

Q Sides of the phalanges (the sides away from the
center of the second toe) of toes two through four
ACTIONS
The dorsal interossei manus and plantar interos-
sei move the toes at the metatarsophalangeal (MTP)
joints.
Plantar Interossei
Q Adduct toes three through five at the MTP joints. A
FIGURE 11-39 Palpation of the dorsal interossei pedis (DIP).

Dorsal Interossei Pedis A, Palpation of the first DIP as the client does tibial abduction
Q Abduct toes two through four at the MTP joints. of the second toe against resistance. Continued
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B C D
11
FIGURE 11-39, cont'd Palpation of the dorsal interossei pedis (DIP). B, Palpation of the second
DIP as the client does fibular abduction of the second toe against resistance. C, Palpation of the
third DIP as the client abducts the third toe against resistance. D, Palpation of the fourth DIP as
the client abducts the fourth toe against resistance.
3. The second dorsal interosseus is palpated between is described as being either tibial abduction or fibular
the second and third metatarsals (Figure 11-39, B). abduction). That leaves toes three, four, and five that can
adduct. The result is that three plantar interossei muscles
4. The third dorsal interosseus is palpated between the attach to toes three, four, and five.
third and fourth metatarsals (Figure 11-39, C).
Q The big toe and the little toe each get their own abductor
5. The fourth dorsal interosseus is palpated between the muscle. That leaves toes two, three, and four to have
fourth and fifth metatarsals (Figure 11-39, D). dorsal interossei pedis muscles attached. However, toe
number two can abduct in the tibial (medial) direction and
in the fibular (lateral) direction; therefore it gets two dorsal
interossei pedis muscles attached to it (one on each side).
TREATMENT CONSIDERATIONS The result is that of the four dorsal interossei pedis muscles,
one attaches to toe number four, one attaches to toe
Q Because we wear shoes
number three, and two attach to toe number two.
so often, we rarely use
our toes. As a result, the
interossei muscles tend
to be weak and poorly
coordinated.
Q The big toe gets its
own adductor, and toe
number two cannot
adduct (its movement
REVIEW QUESTIONS
1. What are the three muscles of the Tom, Dick, and 6. Which of the following muscles crosses the knee
Harry group? joint?
a. Quadratus plantae
________________________________________________ b. Tibialis anterior
c. Soleus
________________________________________________ d. Gastrocnemius
________________________________________________ 7. Which of the following muscles adducts the big

toe?
2. What are the three muscles in plantar layer 1 of the a. Popliteus
foot? b. Abductor hallucis
c. Adductor hallucis
________________________________________________ d. Quadratus plantae
________________________________________________ 8. Which of the following muscles are often referred

to as stirrup muscles?
________________________________________________ a. Tibialis anterior and extensor digitorum longus 11
b. Fibularis brevis and fibularis longus
3. What are the muscles of the triceps surae group? c. Gastrocnemius and soleus
d. Fibularis longus and tibialis anterior
________________________________________________
9. Which of the following muscles attach into the
________________________________________________ tuberosity of the calcaneus?
a. Flexor digitorum brevis and lumbricals pedis
4. Which of the following muscles dorsiflexes and b. Plantaris and gastrocnemius
inverts the foot? c. Abductor hallucis and abductor digiti minimi pedis
a. Tibialis anterior d. Flexor digitorum longus and fibularis tertius
b. Tibialis posterior
c. Extensor digitorum longus 10. What muscles attach into the Achilles tendon?
d. Gastrocnemius a. Gastrocnemius and soleus
b. Soleus and fibularis longus
5. Which of the following muscles plantarflexes and c. Fibularis longus and tibialis anterior
everts the foot? d. Tibialis anterior and gastrocnemius
a. Tibialis anterior
b. Tibialis posterior
c. Fibularis longus
d. Fibularis tertius
CASE STUDY 1
A 34-year-old female client has pain and muscle cramps in 2. How would her activities contribute to this
the back of her right leg (calf). Her pain intensity is 5 to 6 on musculature being tight?
a scale of 0 to 10. The client is a long-distance runner and
has trained 70 to 80 miles per week for the past 10 years. ______________________________________________________
She warms up before running and stretches afterward. Her ______________________________________________________
gait has been professionally evaluated with no reported
problems. The client has no history of traumatic injuries to ______________________________________________________
the region.
Verbal history reveals no life style changes or major ______________________________________________________
changes to her training regimen. She trains with a running ______________________________________________________
club once a week. She finished a half marathon 1 month
earlier. No difference was noted in her pain level or muscle ______________________________________________________
tension after the marathon versus what she has experienced
______________________________________________________
after previous races. Continued questioning revealed that
the client recently took a 2-week vacation driving across the ______________________________________________________
United States.
______________________________________________________
QUESTIONS
11 3. What would be the best treatment plan?
1. Considering the location of her pain, what muscula-
ture do you expect to find tight on this client? ______________________________________________________
______________________________________________________ ______________________________________________________
______________________________________________________ ______________________________________________________
______________________________________________________ ______________________________________________________
______________________________________________________ ______________________________________________________
______________________________________________________ ______________________________________________________
______________________________________________________ ______________________________________________________
______________________________________________________ ______________________________________________________
CASE STUDY 2
A regular client recently made a life-style change by losing 2. What role did running play in this condition?
weight, exercising, and meditation. Her exercise includes
running and weight lifting. The client is now experiencing ______________________________________________________
constant pain on the anterior side of the right leg; the pain ______________________________________________________
intensity varies from a 3 to 6 on a scale of 0 to 10. At first, the
pain occurred only when running; now it occurs with walking. ______________________________________________________
The client’s medical physician ordered an x-ray examination;
the results were negative for fracture or any other osseous ______________________________________________________
pathologic condition. The physician suggested that the client ______________________________________________________
reduce the amount of running and recommended the use an
over-the-counter pain medication. ______________________________________________________
Physical examination of the client’s leg revealed signif-
______________________________________________________
icant tenderness along the lateral border of the shaft of
the tibia. Passive range of motion (ROM), active ROM, and ______________________________________________________
manual resistance to motion of the foot were performed.
The following results were positive with pain in the anterior ______________________________________________________
leg: (1) Passive ROM into extension caused slight pain in
the anterior leg. (2) Active ROM into dorsiflexion caused
3. What role does her dropped arch on weight bearing
moderate pain in the anterior leg. (3) Manual resistance to
have? 11
dorsiflexion and inversion caused strong pain at a level of 6
in the anterior leg. ______________________________________________________
Physical examination shows that the client has a dropped
arch on the right side when weight bearing. Her left arch is ______________________________________________________
normal and healthy.
______________________________________________________
______________________________________________________
QUESTIONS
______________________________________________________
1. What condition do you suspect the client has? What
musculature do you palpate to confirm this? ______________________________________________________
______________________________________________________ ______________________________________________________
______________________________________________________ ______________________________________________________
Appendix:
Stretching Atlas
Appendix
A B C
FIGURE 1 Trapezius.
FIGURE 2 Rhomboids. FIGURE 3 Levator scapulae. FIGURE 4 Posterior deltoid.
435
FIGURE 5 Infraspinatus and teres minor. FIGURE 6 Teres major and latissimus dorsi. FIGURE 7 Supraspinatus.
Appendix
FIGURE 8 Anterior deltoid and pectoralis FIGURE 9 Subscapularis.

major.
436
Appendix
A B
FIGURE 10 Serratus anterior. FIGURE 11 A, Pectoralis major, sternocostal head. B, Pectoralis major,
clavicular head.
FIGURE 12 Pectoralis minor. FIGURE 13 Subclavius.
437
FIGURE 14 Sternocleidomastoid. The client FIGURE 15 Scalene group. FIGURE 16 Longus colli. The client’s head
left laterally flexes and right rotates the and neck are extended and laterally flexed
head and neck and extends the lower neck to the opposite side.
but tucks the chin (flexes the head).
Appendix
FIGURE 17 Hyoid group. The client’s neck FIGURE 18 Splenius capitis. FIGURE 19 Semispinalis capitis. Note:
is extended and left laterally flexed. Flexion is the most important component
of this stretch.
A B
FIGURE 20 Suboccipitals. FIGURE 21 Temporalis.
438
FIGURE 22 Lateral pterygoid. FIGURE 23 Medial pterygoid.
Appendix
FIGURE 24 Deltoid. FIGURE 25 Biceps brachii. FIGURE 26 Brachialis. The client’s elbow
joint is fully extended with the forearm in
position half way between full supination
and full pronation.
FIGURE 27 Coracobrachialis. FIGURE 28 Triceps brachii. FIGURE 29 Brachioradialis. The client’s

forearm is fully extended.
439
FIGURE 30 Pronator teres. FIGURE 31 Wrist flexor group. If ulnar devia- FIGURE 32 Flexors digitorum superficialis
tion is added to the extension, the stretch and profundus.
of the flexor carpi radialis will be enhanced.
Appendix If radial deviation is added to the extension,
the stretch of the flexor carpi ulnaris will be
enhanced.
FIGURE 33 Radial group. FIGURE 34 Flexor pollicis longus. FIGURE 35 Extensor digitorum, extensor
digiti minimi, and extensor indicis.
FIGURE 36 Extensor carpi ulnaris. FIGURE 37 Supinator. Note: It is easy to FIGURE 38 Deep distal four group.
confuse pronation of the forearm at the
radioulnar joints with medial rotation of
the arm at the glenohumeral joint. Be sure
that forearm pronation is being done.
440
A B
FIGURE 39 Thenar group. FIGURE 40 Hypothenar group. A, Abductor digiti minimi manus. B, Flexor digiti minimi
manus and opponens digiti minimi.
Appendix
FIGURE 41 Adductor pollicis. FIGURE 42 Lumbricals manus. FIGURE 43 Palmer interossei.
C
A
B D
FIGURE 44 Dorsal interossei manus.
441
Appendix
FIGURE 45 Latissimus dorsi. FIGURE 46 Erector spinae group. Note: When returning to the
seated position, it is best for the client to place the forearms on the
thighs, using them to push him or herself back up.
FIGURE 47 Transversospinalis group. FIGURE 48 Quadratus lumborum. FIGURE 49 Intercostals. Isolating the
bending to the thoracic region as much
as possible is important.
442
FIGURE 50 Rectus abdominis. The stretch of one side muscle can be enhanced by adding some
lateral flexion to the opposite side.
Appendix
A B
FIGURE 51 Abdominal obliques.
FIGURE 52 Diaphragm. FIGURE 53 Iliopsoas. Note: Keeping the trunk straight or slightly
extended is important.
443
Appendix
FIGURE 54 Gluteus maximus. Note: If the client experiences a FIGURE 55 Gluteus medius and tensor fasciae latae. Note: It is
pinching sensation in the groin with this stretch, it is helpful to important to avoid placing too much weight on the ankle joint of
either first stretch the hip flexors (especially the sartorius and the foot in back.
iliopsoas) before doing this stretch or to first laterally rotate and
abduct the thigh at the hip joint to untwist and slacken the hip
joint capsule before performing the stretch.
FIGURE 57 Quadratus femoris. Note: If the client experiences a pinch-

ing sensation in the groin with this stretch, it is helpful to first stretch
the hip flexors (especially the sartorius and illiopsoas) before stretch-
ing or to first laterally rotate and abduct the thigh at the hip joint to
FIGURE 56 Piriformis. untwist and slacken the hip joint capsule before doing this stretch.
FIGURE 58 Hamstring group. Note: The spine does not need to bend in this stretch.
444
Appendix
FIGURE 59 Sartorius. Note: Not allowing FIGURE 60 Quadriceps femoris. Note: FIGURE 61 Pectineus and gracilis. Note:
the pelvis to fall into an anterior tilt and When performing this stretch, ensuring Not allowing the pelvis to fall into anterior
ensuring that excessive weight is not that the knee joint is not rotated is tilt and ensuring that excessive weight is
placed on the ankle joint of the foot in important. not placed on the ankle joint of the foot in
back are important. back are important.
FIGURE 62 Adductor longus.
FIGURE 63 Adductor magnus.
FIGURE 64 Tibialis anterior.
445
FIGURE 66 Extensor hallucis longus.
Appendix
FIGURE 65 Extensor digitorum longus.
FIGURE 67 Fibularis longus and fibularis brevis.
FIGURE 68 Gastrocnemius. FIGURE 69 Soleus.
446
A
FIGURE 70 Popliteus. FIGURE 71 A, Extensor digitorum brevis. B, Extensor hallucis

brevis.
Appendix
FIGURE 72 A, Tibialis posterior. B, Flexor digitorum longus. C, Flexor hallucis longus.
447
A C
B D
Appendix
FIGURE 73 Dorsal interossei pedis (DIP). A, First DIP. B, Second DIP. C, Third DIP. D, Fourth DIP.
A B
FIGURE 74 A, Abductor hallucis. B, Flexor hallucis brevis.
A B
FIGURE 75 A, Abductor digiti minimi pedis. B, Flexor digiti minimi pedis. FIGURE 76 Flexor digitorum brevis.
448
Bibliography
Aaberg E: Muscle mechanics, ed 2, Champaign, IL, 2006, Human Greene DP, Roberts SL: Kinesiology: movement in the context of activity,
Kinetics. ed 2, St Louis, 2005, Mosby–Elsevier.
Abrahams PH, Marks Jr SC, Hutchings RT: McMinn’s color atlas of Gray’s anatomy for students, New York, 2005, Churchill Livingstone.
human anatomy, ed 5, Edinburgh, 2003, Mosby–Elsevier. Gray’s anatomy, ed 40, New York, 2008, Churchill Livingstone.
Anderson JE: Grant’s atlas of anatomy, ed 7, Baltimore, 1980, Greene DP, Roberts SL: Kinesiology: movement in the context of activity,
Williams & Wilkins. ed 2, St Louis, 2005, Elsevier.
Atlas of anatomy, Germany, 2005, Thieme. Gunn C: Bones & joints: a guide for students, ed 4, Edinburgh, 2002,
Bandy WD, Reese NB: Joint range of motion and muscle length testing, Churchill Livingstone.
Philadelphia, 2002, Saunders–Elsevier. Hamill J, Knutzen JM: Biomechanical basis of human movement, ed 2,
Basmajian JV, De Luca CJ: Muscles alive: their functions revealed by Philadelphia, 2003, Lippincott Williams & Wilkins.
electromyography, ed 5, Baltimore, 1985, Williams & Wilkins. Hoppenfeld S: Physical examination of the spine and extremities, New
Biel A: Trail guide to the body, ed 4, Boulder, CO, 2010, Books of York, 1976, Appleton-Century-Crofts.
Discovery. Jenkins DB: Hollinshead’s functional anatomy of the limbs and back, ed
Biel A: Student handbook: trail guide to the body, Boulder, CO, 2005, 8, Philadelphia, 2002, Saunders–Elsevier.
Books of Discovery. Juhan D: Job’s body: a handbook for bodywork, New York, 1987, Station
Bisschop P, Ombregt L: Atlas of orthopedic examination of the periph- Hill Press.
eral joints, Edinburgh, 1999, Saunders. Kapandji IA: The physiology of the joints, vol 1, ed 5, Edinburgh, 2002,
Burkel WE, Woodburne RT: Essentials of human anatomy, ed 9, New Churchill Livingstone.
York, 1994, Oxford University Press. Kapandji IA: The physiology of the joints, vol 3, ed 2, Edinburgh, 1980,
Cailliet R: Neck and arm pain, ed 2, Philadelphia, 2001, F.A. Davis. Churchill Livingstone.
Calais-Germain B: Anatomy of movement, Seattle, 1993, Eastland Press. Kendall FP, McCreary EK, Provance PG: Muscles: testing and function,
Chaitow L: Palpation and assessment skills, ed 2, Edinburgh, 2003, ed 4, Baltimore, 1993, Williams & Wilkins.
Churchill Livingstone. Lehmkuhl LD, Smith LK, Weiss EL: Brunnstrom’s clinical kinesiology,
Cipriano JJ: Photographic manual of regional orthopaedic and neu- ed 5, Philadelphia, 1996, F.A. Davis.
rological tests, ed 4, Philadelphia, 2003, Lippincott Williams & Leonard CT: The neuroscience of human movement, St Louis, 1998,
Wilkins. Mosby.
Clay JH, Pounds DM: Basic clinical massage therapy, ed 2, Levangie PK, Norkin CC: Joint structure and function: a comprehensive
Philadelphia, 2008, Lippincott Williams & Wilkins. analysis, ed 3, Philadelphia, 2001, F.A. Davis.
Clemente CD: Clemente anatomy, ed 4, Philadelphia, 1997, Liebenson C: Rehabilitation of the spine: a practitioner’s manual,
Lippincott Williams & Wilkins. Philadelphia, 1996, Lippincott Williams & Wilkins.
Cohen BJ: Structure and function of the human body, ed 8, Philadelphia, Lieber RL: Skeletal muscle, structure, function & plasticity, ed 2,
2005, Lippincott Williams & Wilkins. Baltimore, 2002, Lippincott Williams & Wilkins.
Cramer GD, Darby SA: Basic and clinical anatomy of the spine, spinal Lowe W: Orthopedic assessment in massage therapy, Sisters, OR, 2006,
cord, and ANS, St Louis, 1995, Mosby. Daviau Scott Publishers.
Deutsch H, Hamilton N, Luttgens K: Kinesiology: scientific basis Ludwig L, Rattray F: Clinical massage therapy: understanding, assessing
of human motion, ed 8, Madison, WI, 1992, WCB Brown U and treating over 70 conditions, Toronto, 2000, Talus.
Benchmark. Lutjen-Drecoll E, Rohen JW, Yokochi C: Color atlas of anatomy: a
Dixon M: Joint play the right way: axial skeleton, Port Moody, BC, photographic study of the human body, ed 5, Philadelphia, 2002,
2006, Arthrokinetic Publishing. Lippincott Williams & Wilkins.
Dixon M: Joint play the right way: for the peripheral skeleton, Port Magee DJ: Orthopedic physical assessment, ed 4, Philadelphia, 2002,
Moody, BC, 2003, Arthrokinetic Publishing. Saunders–Elsevier.
Earls J, Myers T: Fascial release for structural balance, Chichester, Magill RA: Motor learning and control: concepts and applications, ed 9,
England, 2010, Lotus Publishing. New York, 2011, McGraw Hill.
Enoka RM: Neuromechanics of human movement, ed 3, Champaign, Mense S, Simons DG: Muscle pain: understanding its nature, diag-
IL, 2002, Human Kinetics. nosis, and treatment, Baltimore, 2001, Lippincott Williams &
Field D, Palastanga N, Soames R: Anatomy and human movement, ed Wilkins.
4, Oxford, 2002, Butterworth Heinemann. Muscolino JE: Kinesiology: the skeletal system and muscle function, ed
Findley TW, Schleip R: Fascia research: basic science and implications 2, St Louis, 2011, Mosby–Elsevier.
for conventional and complementary health care, Munich, Germany, Muscolino JE: The muscle and bone palpation manual, St Louis, 2009,
2007, Elsevier. Mosby–Elsevier.
Frankel VH, Nordin M: Basic biomechanics of the musculoskeletal sys- Muscolino JE: The Muscular system manual: the skeletal muscles of the
tem, ed 3, Philadelphia, 2001, Lippincott Williams & Wilkins. human body, ed 3, St Louis, 2010, Mosby–Elsevier.
Gardiner PF, MacIntosh BR, McComas AJ: Skeletal muscle: form and Myers TM: Anatomy trains, ed 2, New York, 2009, Churchill
function, ed 2, Champaign, IL, 2006, Human Kinetics. Livingstone.
Gosling JA, Harris PF, Whitmore I, Willan PLT: Human anatomy: color Netter FH: Atlas of human anatomy, ed 3, Teterboro, NJ, 2003, ICON
atlas and text, ed 4, Edinburgh, 2002, Mosby–Elsevier. Learning Systems.
449
450 Bibliography
Neumann DA: Kinesiology of the musculoskeletal system: foundations Simons DG, Travell JG: Myofascial pain and dysfunction: the trigger
for physical rehabilitation, ed 2, St Louis, 2010, Mosby–Elsevier. point manual—the upper half of the body, vol 1, ed 2, Baltimore,
Norkin CC, White DJ: Measurement of join motion: a guide to goniom- 1999, Williams & Wilkins.
etry, ed 3, Philadelphia, 2003, F.A. Davis. Stone JA, Stone RJ: Atlas of skeletal muscles, ed 4, Boston, 2003,
Oatis CA: Kinesiology: the mechanics & pathomechanics of human McGraw-Hill.
movement, Philadelphia, 2004, Lippincott Williams & Wilkins. Tixa S: Atlas of palpatory anatomy of limbs and trunk, Teterboro, NJ,
Olson TR: A.D.A.M. student atlas of anatomy, Baltimore, 1996, 2003, ICON Learning Systems.
Williams & Wilkins. Warfel JH: The extremities, ed 4, Philadelphia, 1981, Lea & Febiger.
Patton KT, Thibodeau GA: Anatomy & physiology, ed 7, St Louis, 2010, Warfel JH: The head, neck and trunk, ed 4, Philadelphia, 1978, Lea
Mosby–Elsevier. & Febiger.
Simons DG, Travell JG: Myofascial pain and dysfunction: the trig- Watkins J: Structure and function of the musculoskeletal system,
ger point manual—the lower extremities, vol 2, Baltimore, 1999, Champaign, IL, 1999, Human Kinetics.
Williams & Wilkins. White TD: Human osteology, ed 2, San Diego, 2000, Academic Press.
Index
Abductor hallucis—cont'd Adductor brevis
A
attachments, 419 functions, 339–340
Abdominal obliques, stretching exercise for, derivation, 419 hip joint, crossing, 339–340
443f functions, 386 innervation, 368
Abdominal wall muscles, 268–272 innervation, 419 palpation, 368, 368f
actions, 270–271 palpation, 419, 420f pronunciation, 366
anterior views of, 268f–269f plantar view of, 418f reverse mover actions, 339–340
attachments, 270 pronunciation, 418 structures, relationship, 366
derivation, 270 reverse mover actions, 386 treatment considerations, 370
innervation, 271 stretching exercise for, 448f Adductor gracilis, 366–370
lateral views of, 268f–269f structures, relationship, 418 Adductor group, 366–370. See also Adductor
palpation, 271–272 treatment considerations, 421 brevis; Adductor longus; Adductor
pronunciation, 268 Abductor indicis, 236 magnus; Gracilis; Pectineus
structures, relationship, 268 Abductor pollicis brevis, 222–224. See also actions, 368
treatment considerations, 272 Thenar eminence group anterior views of, 366f–367f
Abduction, 9 actions, 223 attachments, 367–368
Abductor digiti minimi manus (ADMM), anterior views of, 222f cautionary note, 370
226-228 attachments, 223 derivation, 367
actions, 227 derivation, 223 functions, 339–340
deep view of, 226f functions, 182–183 hip joint, crossing, 339–340
attachments, 227 innervation, 223 innervation, 368
CMC/MCP joints, crossing, 183 palpation, 223–224 palpation, 368–370, 368f–370f
deep view of, 226f pronunciation, 222 posterior view of, 367f
derivation, 227 reverse mover actions, 182–183 pronunciation, 366
functions, 183 structures, relationship, 222 reverse mover actions, 339–340
palpation, 227–228 thumb, first CMC joint crossing, structures, relationship, 366
pronunciation, 226 182–183 treatment considerations, 370
reverse mover actions, 183 treatment considerations, 224 Adductor hallucis, 424–425. See also Intrinsic
stretching exercise for, 441f Abductor pollicis longus, 218–220. See also foot—plantar layer III
structures, relationships, 226 Deep distal four group actions, 425
treatment considerations, 228 actions, 219 attachments, 425
Abductor digiti minimi pedis, 418–421. See attachments, 219 derivation, 425
also Intrinsic foot—plantar layer I derivation, 219 functions, 386
actions, 419 first CMC joint, crossing, 182 innervation, 425
attachments, 419 functions, 182 MTP joint, crossing, 386
derivation, 419 innervation, 219 palpation, 426, 426f
functions, 386 posterior view of, 218f plantar view of, 424f
innervation, 419 pronunciation, 218 pronunciation, 424
MTP joint, crossing, 386 reverse mover actions, 182 reverse mover actions, 386
palpation, 419–420, 420f structures, relationship, 218 structures, relationship, 424
plantar view of, 418f treatment considerations, 220 treatment considerations, 426
pronunciation, 418 Adduction, 9 Adductor longus, 366–368. See also Adductor
reverse mover actions, 386 Adductor brevis, 366–368. See also Adductor group
stretching exercise for, 448f group actions, 368
structures, relationship, 418 actions, 368 anterior view of, 366f
treatment considerations, 421 anterior views of, 366f attachments, 367
Abductor hallucis, 418–421. See also Intrinsic attachments, 367 cautionary note, 363
foot—plantar layer I cautionary note, 370 derivation, 367
actions, 419 derivation, 367 functions, 339–340
451
452 Index
Adductor longus—cont'd Anterior abdominal wall muscles—cont'd Atlantoaxial joint, 45f

hip joint, crossing, 339–340 anterior views of, 268f–269f Atlanto-occipital joint (AOJ)
innervation, 368 attachments, 270 lateral flexion motions, posterior views
palpation, 368, 368f derivation, 270 of, 22f
pronunciation, 366 functions, 242 longus capitis, crossing, 242
reverse mover actions, 339–340 innervation, 271 rectus capitis lateralis, crossing, 242
stretching exercise for, 445f lateral views of, 268f–269f rotation motions, posterior views of, 22f
structures, relationship, 366 palpation, 271–272, 271f sagittal plane motions, lateral views of,
treatment considerations, 370 treatment considerations, 272 21f
Adductor magnus, 366–368. See also Anterior distal ulna, 202 splenius capitis, crossing, 242
Adductor group Anterior hand, radial side, 192f–196f Atlas, 127f, 277
actions, 368 Anterior head, 370 Attachments. See also Muscle attachment
attachments, 367 Anterior inferior iliac spine (AIIS), 373 insertion, 91
cautionary note, 363 Anterior scalene, 282–283. See also Scalene origin, 91
derivation, 367 group Auricularis anterior, 310–313
functions, 339–340 actions, 283 actions, 311
hip joint, crossing, 339–340 anterior view of, 282f attachments, 311
innervation, 368 attachments, 282–283 derivation, 311
palpation, 369–370, 370f cautionary note, 283 innervation, 311
posterior view of, 367f cervical spinal joints, crossing, 242 lateral view of, 310
pronunciation, 366 derivation, 282 palpation, 312
reverse mover actions, 339–340 functions, 242 lateral view of, 310f
stretching exercise for, 445f innervation, 283 pronunciation, 310
structures, relationship, 366 palpation, 283 structures, relationship, 310
treatment considerations, 370 pronunciation, 282 treatment considerations, 313
Adductor pollicis, 232–236. See also Central reverse mover actions, 242 Auricularis posterior, 310–313
compartment group structures, relationship, 282 actions, 311
actions, 233 syndrome, 283 attachments, 311
anterior view of, 232f treatment considerations, 283 derivation, 311
attachments, 233 Anterior scalene syndrome, 283 innervation, 311
CMC joint, crossing, 182–183 Anterior shin splints, 395 lateral view of, 310
derivation, 233 Anterior superior iliac spine (ASIS), 134f, palpation, 312
functions, 182–183 361 lateral view of, 310f
innervation, 234 Anterolateral lumbar spine, 361 pronunciation, 310
palpation, 234 Anterolateral views of, 8f structures, relationship, 310
pronunciation, 232 AOJ. See Atlanto-occipital joint treatment considerations, 313
reverse mover actions, 182–183 Aponeurosis, 93 Auricularis superior, 310–313
stretching exercise for, 441f Appendicular body, 3f–4f actions, 311
structures, relationship, 232 Arm, glenohumeral joint, 14–15 attachments, 311
treatment considerations, 236 abduction, 142 derivation, 311
Amphiarthrotic joints, 41 sagittal plane actions, 14f innervation, 311
Anconeus, 176–177 transverse plane actions, 15f lateral view of, 310
actions, 176 trunk, reverse actions, 15f–16f palpation, 312
attachments, 176 Arm, motions lateral view of, 310f
derivation, 176 brachialis muscle, movement (impact), pronunciation, 310
functions, 172 89–90 structures, relationship, 310
innervation, 176 frontal plane, 7f treatment considerations, 313
palpation, 176–177 oblique plane, 7f Axial body, 3f–4f, 124f–131f
posterior view of, 176f Articular processes of cervical spine, 128f Axis (axes), 8
pronunciation, 176 Articularis genus, 376 imaginary line, 8
reverse mover actions, 142 actions, 376 spinous process, 277
structures, relationship, 176 anterior view of, 376f
treatment considerations, 177 attachments, 376
B
Anterior, 2 derivation, 376
Anterior abdominal wall muscles, 268–272. functions, 340 Ball-and-socket joint, 45
See also External abdominal palpation, 376 Basilar arthritis, 224
oblique; Internal abdominal pronunciation, 376 Belly breathing, 267
oblique; Rectus abdominis; structures, relationship, 376 Biaxial condyloid joints, 45f
Transversus abdominis treatment considerations, 376 Biaxial joints, 44
actions, 270–271 ASIS. See Anterior superior iliac spine Biaxial saddle joint, 46f
Index 453
Biceps brachii, 170–171 Brachioradialis—cont'd Christmas tree muscles, 149f

actions, 170 functions, 182 Circumduction, 10
anterior view of, 170f hitchhiker muscle, 205 Clavicle, sternoclavicular joint, 14f
attachments, 170 innervation, 205 CMC. See Carpometacarpal (CMC) joint
derivation, 170 palpation, 205 Coccyx, 132f
elbow, crossing, 97–98 pronunciation, 204 Common carotid artery, 290
elbow joint flexion, 205 reverse mover actions, 182 Concentric contractions, 88–89
functions, 141–142 stretching exercise for, 439f Condyloid joints. See Biaxial condyloid
innervation, 170 structures, relationship, 204 joints
palpation, 171 treatment considerations, 205 Contractions. See Concentric contractions;
pronunciation, 170 Buccinator, 322–334 Eccentric contractions; Isometric
reverse mover actions, 141–142 actions, 326 contractions
stretching exercise for, 439f anterior view of, 328f Coracobrachialis, 168–169
structures, relationship, 170 attachments, 326 actions, 168
treatment considerations, 171 derivation, 325 anterior view of, 168f
Biceps femoris, 378–380. See also Hamstring function, 300 attachments, 168
group innervation, 330 cautionary note, 169
actions, 379 lateral view of, 324f derivation, 168
attachments, 379 palpation, 332, 332f GH joint, crossing, 141–142
derivation, 379 pronunciation, 322 innervation, 168
functions, 339–340 structures, relationship, 322 palpation, 169
innervation, 379 treatment considerations, 334 pronunciation, 168
knee joint, crossing, 339–340 reverse mover actions, 141–142
palpation, 379–380, 379f–380f stretching exercise for, 439f
C
posterior views of, 378f structures, relationship, 168
pronunciation, 378 C1-C7, 127f treatment considerations, 169
reverse mover actions, 339–340 C2-C7, 128f Coronoid process, 70f
structures, relationship, 378 Calcaneal tuberosity, 139f Corrugator supercilii, 314–316
treatment considerations, 380 Calcaneus, 138f actions, 315
Bicipital groove, 120f Caninus, 334 anterior view of, 314f
Body Cardinal planes, 8 attachments, 314
anatomic position, 2, 5 Carotid sinus, 290 derivation, 314
anterior view of, 3f Carpal tunnel syndrome, 209 function, 300
anterolateral views of, 6f–8f Carpometacarpal (CMC) joint innervation, 315
lateral view of, 4f abductor pollicis brevis, crossing, 182–183 palpation, 316, 316f
posterior view of, 3f abductor pollicis longus, crossing, 182 pronunciation, 314
Body parts, 5–7 adductor pollicis, crossing, 182–183 structures, relationship, 314
Bony palpation extensor pollicis longus, crossing, treatment considerations, 316
axial body, 124f–131f 182–183 Costoclavicular syndrome, 157
lower extremities, 131f–139f flexor pollicis longus, crossing, 182–183 Cranial/caudal, terms (pairs), 4
upper extremity, 117f–124f Central compartment group, 232–236. See Cross-bridges, 94
Botox, 334 also Adductor pollicis; Lumbricals Cuboid, 139f
Brachialis, 172–173 manus; Palmar interossei; Dorsal
actions, 172 interossei manus
D
derivation, 172 actions, 233
functions, 141–142 anterior views of, 232 de Quervain's disease, 220
elbow joint flexion, 205 attachments, 233 Deep, 4
innervation, 172 derivation, 233 Deep distal four group, 218-220. See also
palpation, 172–173 functions, 182-183 Abductor pollicis longus; Extensor
pronunciation, 172 innervation, 234 indicis; Extensor pollicis brevis;
reverse mover actions, 141–142 palpation, 234–236 Extensor pollicis longus
stretching exercise for, 439f posterior view of, 232 actions, 219
structures, relationship, 172 pronunciation, 232 attachments, 219
treatment considerations, 173 reverse mover actions, 182-183 derivation, 219
Brachioradialis, 204–205 stretching exercise for, 441f innervation, 219
actions, 204–205 structures, relationship, 232 palpation, 220
anterior view of, 204f treatment considerations, 236 posterior views of, 218f
attachments, 204 Cervical spine pronunciation, 218
derivation, 204 articular processes of, 128f reverse mover actions, 182-183
elbow joint flexion, 205 laminar groove of, 128f stretching exercise for, 440f
454 Index
Deep distal four group—cont'd Depressor septi nasi—cont'd Dorsal interossei manus—cont'd
structures, relationship, 218 palpation, 320, 321f functions, 182–183
treatment considerations, 220 pronunciation, 318 innervation, 234
Deep lateral rotator group, 350–354 See structures, relationship, 318 palpation, 235, 236f
also Inferior gemellus; Obturator treatment considerations, 321 posterior view of, 232f
externus; Obturator internus; Depressor supercilii, 316 pronunciation, 233
Piriformis; Quadratus femoris; Diaphragm, 266–267 reverse mover actions, 182–183
Superior gemellus actions, 266 stretching exercise for, 441f
actions, 352 anterior view of, 266f structures, relationship, 232
attachments, 352 aponeurotic central tendon (dome), 266 treatment considerations, 236
cautionary note, 354 attachments, 266 Dorsal interossei pedis (DIP), 428–430.
derivation, 351 contraction, 267 See also Intrinsic foot—plantar
functions, 339–340 derivation, 266 layer IV
innervation, 352 functions, 242 actions, 429
palpation, 353, 353f inferior view of, 266f attachments, 429
posterior views of, 350f–351f innervation, 266 derivation, 429
pronunciation, 350 palpation, 266 dorsal view of, 428f
structures, relationship, 350 pronunciation, 266 functions, 386
treatment considerations, 354 reverse mover actions, 242 innervation, 429
Deltoid, 166–167 stretching exercise for, 443f MTP joint, crossing, 386
attachments, 166 structures, relationship, 266 palpation, 429–430, 429f–430f
derivation, 166 treatment considerations, 267 pronunciation, 428
functions, 141–142 Diarthrotic joints, 41 reverse mover actions, 386
GH joint, crossing, 141–142 Diarthrotic synovial joints, 41 stretching exercise for, 448f
innervation, 167 Digastric, 284–287. See also Suprahyoid structures, relationship, 428
palpation, 167 muscles Dorsal surface. See Intrinsic foot—dorsal
pronunciation, 166 actions, 286 surface
reverse mover actions, 141–142 anterior view of, 284f Dorsal tubercle, 122f
stretching exercises for, 435f, 436f, 439f attachments, 286 Dorsiflexion, 10, 37f
structures, relationship, 166 derivation, 285 Downward rotation, 10
treatment considerations, 167 functions, 242 Downward tilt, 10
Depression, 9 innervation, 286 Dracula expression, 331
Depressor anguli oris, 322–334 lateral view of, 284f
actions, 326 mandible, attachment, 286–287
E
anterior views of, 324f, 328f palpation, 286–287, 287f
attachments, 326 pronunciation, 285 Eccentric contractions, 91–92
derivation, 325 reverse mover actions, 242 Eight-pack (8-pack) muscle, 272
function, 300 structures, relationship, 284 Elbow
innervation, 330 treatment considerations, 287 forearm, 17
palpation, 331, 331f DIM. See Dorsal interossei manus humeroulnar joint, 44f
pronunciation, 322 DIP. See Distal interphalangeal Elbow joint
structures, relationship, 322 Distal, 2 biceps brachii, crossing, 97–98
treatment considerations, 334 Distal attachment, movement, 89–90 flexion, 205
Depressor labii inferioris, 322–334 Distal forearm forearm, flexion, 17f
actions, 326 approach. See Proximal arm motion, 176–177
anterior views of, 324f, 329f movement, 89f triceps brachii, crossing, 141–142
attachments, 326 proximal arm approach, 89f Elevation, 9
derivation, 325 Distal interphalangeal (DIP) joints Endomysium (endomysia), 93, 93f
function, 300 extensor digitorum, crossing, 183 Epicranius. See Occipitofrontalis;
innervation, 330 finger movement, 183 Temporoparietalis
palpation, 332, 333f reverse actions, 183 Epimysium, 93, 93f
pronunciation, 322 Distal posterior fibula, 411 Erector spinae group, 250–251. See also
structures, relationship, 322 Distal posterior forearm, 218–220 Iliocostalis; Longissimus; Spinalis
treatment considerations, 334 Distal posterolateral femur, 414 actions, 251
Depressor septi nasi, 318–321 Dorsal, 2–4 attachments, 251
actions, 319 Dorsal digital expansion, 182, 399 derivation, 250
anterior views of, 318f, 319f Dorsal interossei manus (DIM), 232–236. See functions, 242
attachments, 318 also Central compartment group innervation, 251
derivation, 318 actions, 233 palpation, 251
function, 300 attachments, 233 posterior view of, 250f
innervation, 319 derivation, 233 pronunciation, 250
Index 455
Erector spinae group—cont'd Extensor digitorum, 214–215 Extensor hallucis longus—cont'd

reverse mover actions, 242 actions, 215 functions, 386
spinal joints, crossing, 242 attachments, 215 innervation, 396
stretching exercise for, 442f derivation, 214 palpation, 396–397, 397f
structures, relationship, 250 extensor digiti minimi, blends, 215 pronunciation, 396
treatment considerations, 251 functions, 183 reverse mover actions, 386
Eversion, 10, 37f innervation, 215 structures, relationship, 396
Extension, 9 MCP/PIP/DIP joints, crossing, 183 treatment considerations, 397
Extensor carpi radialis brevis. 210–213. See palpation, 215 Extensor indicis, 218–220. See also Deep
also Wrist extensor group posterior view of, 214f distal four group
actions, 211 pronunciation, 214 actions, 219
attachments, 211 structures, relationship, 214 attachments, 219
derivation, 211 stretching exercise for, 440f derivation, 219
functions, 182 treatment considerations, 215 functions, 182–183
innervation, 211 Extensor digitorum brevis, 416–417 innervation, 219
palpation, 211–212 actions, 417 palpation, 220
posterior view of, 214f attachments, 416 posterior views of, 218f
pronunciation, 210 derivation, 416 pronunciation, 219
structures, relationship, 210 dorsal view of, 416f stretching exercise for, 440f
treatment considerations, 213 functions, 386 structures, relationship, 218
wrist joint, crossing, 182 innervation, 417 treatment considerations, 220
Extensor carpi radialis longus. 210–213. See palpation, 417, 417f Extensor pollicis brevis, 218–220. See also
also Wrist extensor group pronunciation, 416 Deep distal four group
actions, 211 reverse mover actions, 386 actions, 219
attachments, 211 stretching exercise for, 447f attachments, 219
derivation, 211 structures, relationship, 416 derivation, 219
functions, 182 toe joints, crossing, 386 functions, 182–183
innervation, 211 treatment considerations, 417 innervation, 219
palpation, 212 Extensor digitorum longus, 398–399 palpation, 220
posterior view of, 210f actions, 398 posterior view of, 218f
pronunciation, 210 anterior view of, 398f pronunciation, 219
structures, relationship, 210 attachments, 398 reverse mover actions, 182–183
treatment considerations, 213 derivation, 398 structures, relationship, 218
wrist joint, crossing, 182 functions, 386 treatment considerations, 220
Extensor carpi ulnaris (wrist extensor group), innervation, 398 Extensor pollicis longus (deep distal four
210–213 palpation, 398–399, 399f group), 218–220
actions, 211 pronunciation, 398 actions, 219
attachments, 211 reverse mover actions, 386 attachments, 219
derivation, 211 stretching exercise for, 446f CMC joint, crossing, 182–183
functions, 182 structures, relationship, 398 derivation, 219
innervation, 211 toe joints, crossing, 386 functions, 182–183
palpation, 212 treatment considerations, 399 innervation, 219
posterior view of, 210f Extensor expansion, 182 palpation, 220
pronunciation, 210 Extensor hallucis brevis, 416–417 pronunciation, 218
stretching exercise for, 440f actions, 417 reverse mover actions, 182–183
structures, relationship, 210 attachments, 417 structures, relationship, 218
treatment considerations, 213 derivation, 416 treatment considerations, 220
wrist joint, crossing, 182 dorsal view of, 416f External abdominal oblique, 268–272.
Extensor digiti minimi, 214–215 functions, 386 See also Abdominal wall
actions, 215 innervation, 417 muscles
attachments, 215 palpation, 417 actions, 270
derivation, 214 pronunciation, 416 anterior view of, 268f
functions, 183 reverse mover actions, 386 attachments, 270
innervation, 215 stretching exercise for, 447f derivation, 270
MCP, crossing, 183 structures, relationship, 416 functions, 242
palpation, 215 Extensor hallucis longus, 396–397 innervation, 271
posterior view of, 214f actions, 396 lateral views of, 268f
pronunciation, 214 anterior view of, 396f palpation, 271, 271f
reverse mover actions, 183 attachments, 396 pronunciation, 270
stretching exercise for, 440f big toe, crossing, 386 reverse mover actions, 242
structures, relationship, 214 derivation, 396 spinal joints, crossing, 242
456 Index
External abdominal oblique—cont'd Fibrous joints, 44f Flexor carpi radialis—cont'd

structures, relationship, 268 Fibula, 136f anterior view of, 198f
treatment considerations, 272 Fibular, 4 attachments, 199
External intercostals, 260–261 Fibular abduction, 430 derivation, 199
actions, 261 Fibularis brevis, 400–402 functions, 182
anterior view of, 260f actions, 401 innervation, 199
attachments, 261 attachments, 401 palpation, 200
derivation, 261 derivation, 400 pronunciation, 198
functions, 242 foot, crossing, 386 reverse mover actions, 182
innervation, 261 functions, 386 structures, relationship, 198
location, 260 innervation, 401 treatment considerations, 201
palpation, 261, 261f lateral view of, 400f Flexor carpi ulnaris, 198–201. See also wrist
pronunciation, 260 palpation, 401, 401f–402f flexor group
reverse mover actions, 242 pronunciation, 400 actions, 199
structures, relationship, 260 reverse mover actions, 386 attachments, 199
treatment considerations, 261 stretching exercise for, 446f derivation, 199
External occipital protuberance, 126f, 146 structures, relationship, 400 functions, 182
External pterygoid, 308 treatment considerations, 402 innervation, 199
Extrinsic finger, muscles Fibularis group, 400–402. See Fibularis palpation, 200
anterior views brevis; Fibularis longus; Fibularis pronunciation, 198
deep, 186f tertius reverse mover actions, 182
intermediate, 185f Fibularis longus, 400–402 structures, relationship, 198
superficial, 184f, 187f actions, 401 treatment considerations, 201
lateral view of, 190f attachments, 401 wrist joint, crossing, 182
medial view of, 189f derivation, 400 Flexor digiti minimi manus, 226–228. See
posterior view functions, 386 also Hypothenar eminence group
intermediate/deep views of, 188f innervation, 401 actions, 227
superficial, 187f lateral view of, 400f anterior view of, 226f
Eyebrows palpation, 401, 401f–402f attachments, 227
fascia/skin medial, 318 pronunciation, 400 derivation, 227
medial portion, fascia/skin deep, 315 reverse mover actions, 386 functions, 182–183
Eyes, 314–316 stretching exercise for, 446f innervation, 227
medial side, 314 structures, relationship, 400 palpation, 227–228, 228f
treatment considerations, 402 pronunciation, 226
Fibularis tertius, 400–402 reverse mover actions, 182–183
F actions, 401 structures, relationship, 226
Face ankle joint, crossing, 386 treatment considerations, 228
anterior view of, 302f anterior view of, 400f Flexor digiti minimi pedis, 424–425. See also
oblique view of, 124f attachments, 401 Intrinsic foot—plantar layer III
Facial expression muscles. See also specific definition of, 399 actions, 425
muscle derivation, 400 attachments, 425
innervation, 315, 319, 330 functions, 400 derivation, 425
muscle function, 300 innervation, 401 functions, 386
overview of, 299 palpation, 402, 402f innervation, 425
treatment considerations, 316 pronunciation, 400 MTP joint, crossing, 386
Fan-shaped muscle, demonstration, 95f reverse mover actions, 386 palpation, 425, 426f
Fascicles, 93, 93f structures, relationship, 400 plantar view of, 424f
FDP. See Flexor digitorum profundus treatment considerations, 402 pronunciation, 424
FDS. See Flexor digitorum superficialis Fifth metatarsal, 138f reverse mover actions, 386
Femoral condyles, 135f Finger stretching exercise for, 441f, 448f
Femur MCP joints, 19f structures, relationship, 424
functions, 386 metacarpals, 233 treatment considerations, 426
greater trochanter, 134f, 347, 352 proximal phalanges, 233 Flexor digitorum accessorius, 423
head (hip joint), 47f Finger joint Flexor digitorum brevis, 418–421. See also
intertrochanteric crest, 352 extrinsic muscles of, 183 Intrinsic foot—plantar layer I
lesser trochanter, 134f, 361 intrinsic muscles of, 181–182 actions, 419
linea aspera, 367, 373 Fixed attachment, 88–89 attachments, 419
trochanteric fossa, 352 Flexion, 9 derivation, 419
Fibrous fascia Flexor carpi radialis, 198–201. See also wrist functions, 386
muscle envelopment, 93b flexor group innervation, 419
sheath, 93f actions, 199 MTP/PIP joints, crossing, 386
Index 457
Flexor digitorum brevis—cont'd Flexor hallucis brevis—cont'd Foot. See also Right foot
palpation, 420, 420f stretching exercise for, 448f fibularis brevis, crossing, 386
plantar view of, 418f structures, relationship, 424 fixation, 90
pronunciation, 418 Flexor hallucis longus, 410–413. See also lateral rotation (abduction), 37f
reverse mover action notes, 386 Tom, Dick, and Harry group medial view of, 137f
stretching exercise for, 448f actions, 411 opponens hallucis, 426
structures, relationship, 418 attachments, 411 plantar view of, 139f
treatment considerations, 421 big toe, crossing, 386 pronation, 10
Flexor digitorum longus, 410–413. See also derivation, 411 oblique plane, 37f
Tom, Dick, and Harry group functions, 386 stipulation, oblique plane, 37f
actions, 411 innervation, 411 subtalar/tarsal joint, 37, 37f
attachments, 411 palpation, 413, 413f talocrural joint, 36f
derivation, 411 posterior view of, 410f toes, 139f
functions, 386 pronunciation, 410 Foot, ankle joint, 36–37
innervation, 411 reverse mover actions, 386 dorsiflexion/plantarflexion, 36f
muscle, distal tendon, 423 stretching exercise for, 447f eversion/inversion, 37f
palpation, 412–413, 412f–413f structures, relationship, 410 lateral/medial rotation, 37
posterior view of, 410f Flexor pollicis brevis, 222–224. See also motion, 37f
pronunciation, 410 Thenar eminence group Forearm. See also Right forearm
reverse mover actions, 386 actions, 223 elbow, 17, 17f
stretching exercise for, 447f anterior views of, 222f flexor pollicis longus, 206–209
structures, relationship, 410 attachments, 223 motions, sagittal plane, 7f
toe joints, crossing, 386 derivation, 223 movement, 89f
treatment considerations, 413 functions, 182–183 muscles, radial group, 204–205, 210–213
Flexor digitorum profundus (FDP), 206–209 innervation, 223 pronation, 10
actions, 207 palpation, 223–224 radioulnar joints, 17
anterior view of, 206f pronunciation, 222 transverse plane cross-sections, 191f
attachments, 207 structures, relationship, 222 wrist extensor group, 210–213
derivation, 207 thumb, CMC joint (crossing), Fourth hamstring, 370
functions, 182 182–183 Frontal plane, 5b
innervation, 207 treatment considerations, 224 examples, 6f
palpation, 208 Flexor pollicis longus, 206–209 head/neck/arm, motions (example), 7f
pronunciation, 206 actions, 207 motion, occurrence, 8f
stretching exercise for, 440f anterior view of, 206f Frontalis, 311
structures, relationship, 206 attachments, 207 Full skeleton
treatment considerations, 209 derivation, 207 anterior view of, 42f
Flexor digitorum superficialis (FDS), functions, 182 posterior view of, 43f
206–209 innervation, 207 Functional short leg, 349
actions, 207 palpation, 208 Fusiform-shaped muscle, 95f
anterior view of, 206f pronunciation, 206
attachments, 207 reverse mover actions, 182
G
derivation, 207 stretching exercise for, 440f
functions, 182 structures, relationship, 206 Galea aponeurotica, 311
innervation, 207 treatment considerations, 209 Gastrocnemius, 404–406. See also Triceps
palpation, 208 Flexor retinaculum, 223, 227 surae group
pronunciation, 206 Flexor digitorum and pollicis group, actions, 405
stretching exercise for, 440f 206–209. See also Flexor attachments, 405
structures, relationship, 206 digitorum superficialis; Flexor derivation, 404
treatment considerations, 209 digitorum profundus; Flexor functions, 386
Flexor hallucis brevis, 424–425. See also pollicis longus innervation, 405
Intrinsic foot—plantar layer III actions, 207 palpation, 405, 405f
actions, 425 anterior view of, 206f posterior view of, 404f
attachments, 425 attachments, 207 pronunciation, 404
derivation, 425 derivation, 207 reverse mover actions, 386
functions, 386 functions, 182 structures, relationship, 404
innervation, 425 innervation, 207 treatment considerations, 406
MTP joint, crossing, 386 palpation, 208 Geniohyoid, 284–287. See also Suprahyoid
palpation, 425, 426f pronunciation, 206 muscles
plantar view of, 424f reverse mover actions, 182 actions, 286
pronunciation, 424 structures, relationship, 206 anterior view of, 285f
reverse mover actions, 386 treatment considerations, 209 attachments, 286
458 Index
Geniohyoid—cont'd Gluteus minimus—cont'd Head—cont'd

derivation, 285 reverse mover actions, 339–340 atlanto-occipital joint—cont'd
functions, 242 structures, relationship, 346 sagittal plane motions, lateral views
innervation, 286 treatment considerations, 349 of, 21f
lateral view of, 285f Golf tee muscles, 275 bones
palpation, 286–287, 287f Golfer's elbow, 201, 203, 209 anterior view of, 68f
pronunciation, 285 Gracilis, 366–368. See also Adductor group inferior view of, 72f
reverse mover actions, 242 actions, 368 lateral view of, 70f
structures, relationship, 284 anterior view of, 367f bony landmarks
treatment considerations, 287 attachments, 368 anterior view of, 68f
Girdle. See Shoulder girdle cautionary note, 370 inferior view of, 72f
Glenohumeral (GH) joint, 14–15 derivation, 367 lateral view of, 72f
frontal plane actions, 14f functions, 339–340 left lateral flexion, 22f
functional group approach, application, hip joint, crossing, 339–340 right lateral flexion, 22f
97–98 innervation, 368 sternocleidomastoid (SCM), 280–281
sagittal plane actions, 14f palpation, 369, 369f Head, motions
transverse plane actions, 15f pronunciation, 366 frontal plane, 7f
trunk, 15f–16f reverse mover actions, 339–340 oblique plane, 7f
Gluteal aponeurosis, 349 stretching exercise for, 445f sagittal plane, 7f
Gluteal fascia, 349 structures, relationship, 366 transverse plane, 7f
Gluteal fold, 133f treatment considerations, 370 Head, muscles, 301f
Gluteal group, 346–349. See Gluteus Gravity, force (impact), 91–92 attachment sites
maximus; Gluteus medius; anterior view of, 69f
Gluteus minimus inferior view of, 73f
H
Gluteus maximus, 346–349 lateral view of, 71f
actions, 347 Hamate, 124f, 227 superficial lateral view of, 301f–302f,
attachments, 347 Hamstring group, 378–380. See also Biceps 301–302
derivation, 347 femoris; Semimembranosus; superficial posterior view of, 302, 302f
functions, 339–340 Semitendinosus superficial right lateral view of, 301f
innervation, 347 actions, 379 Hinge joints, 41
palpation, 347, 348f attachments, 379 Hip joint
posterior view of, 346f derivation, 379 adductor brevis, crossing, 339–340
pronunciation, 346 functions, 339–340 adductor longus, crossing, 339–340
reverse mover actions, 339–340 innervation, 379 adductor magnus, crossing, 339–340
stretching exercise for, 444f palpation, 379–380, 379f–380f flexion/extension, sagittal plane
structures, relationship, 346 posterior views of, 378f (mediolateral axis), 47f
treatment considerations, 349 pronunciation, 378 gluteus medius, crossing, 339–340
Gluteus medius, 346–349 stretching exercise for, 444f gluteus minimus, crossing, 339–340
actions, 347 structures, relationship, 378 gracilis, crossing, 339–340
attachments, 347 treatment considerations, 380 medial/lateral rotation, transverse plane,
derivation, 347 Hand. See also Right hand 47f
functions, 339–340 abduction/adduction, frontal plane pectineus, crossing, 339–340
hip joint, crossing, 339–340 (anteroposterior axis), 19f sartorius, crossing, 339–340
innervation, 347 fixation, 89f TFL, crossing, 339–340
lateral view of, 346f flexion/extension triaxial ball-and-socket joint, example,
palpation, 348, 348f lateral views of, 18f 47f
pronunciation, 346 sagittal joint, mediolateral axis, 45f Hip joint, muscles
reverse mover actions, 339–340 heavy weight (holding), 147 function, overview of, 339–340
stretching exercise for, 444f metacarpophalangeal joint, 45f overview of, 339–340
structures, relationship, 346 midcarpal joints, motions, 18f structure, overview of, 339–340
treatment considerations, 349 radial deviation (abduction), 18f Hip joint, pelvis, 32–34
Gluteus minimus, 346–349 radiocarpal joints, motions, 18f depression/elevation, anterior views of,
actions, 347 ulnar deviation (adduction), 18f 32f–34f
attachments, 347 wrist joint, motions, 18f motion, 32f–34f
derivation, 347 Hand musculature, posterior/dorsal views posterior/anterior tilt, lateral views of,
functions, 339–340 of, 233f 32f–34f
hip joint, crossing, 339–340 Head rotation, anterior/superior views of,
innervation, 347 atlanto-occipital joint 32f–34f
lateral view of, 346f lateral flexion motions, posterior Hip joint, thigh, 30–31
palpation, 348, 348f views of, 22f abduction/adduction, anterior views of, 31f
pronunciation, 346 rotation motions, posterior views of, 22f flexion/extension, lateral views of, 30f
Index 459
Hip joint, thigh—cont'd Iliacus—cont'd Infraspinatus—cont'd

lateral/medial rotation, anterior views cautionary note, 363 actions, 163
of, 31f derivation, 361 attachments, 163
motions, 30f–31f functions, 339–340 derivation, 162
Hitchhiker muscle, 205 innervation, 361 functions, 141–142
Hook of the hamate, 124f palpation, 361–362, 362f innervation, 163
Horizontal extension, 10 pronunciation, 360 palpation, 163–165
Horizontal flexion, 10 reverse mover actions, 339–340 posterior views of, 162f
Horizontal flexion/horizontal extension, structures, relationship, 360 pronunciation, 162
terms (pairs), 10 treatment considerations, 363 reverse mover actions, 141–142
Humeroulnar joint, elbow, 44f Iliocostalis, 250–251. See also Erector spinae stretching exercise for, 436f
Humerus group structures, relationship, 162
greater tubercle, 120f, 163 actions, 251 treatment considerations, 165
lateral epicondyle, 121f, 176, 217 attachments, 251 Insertion
lesser tubercle, 120f derivation, 250 attachments, contrast, 91
medial epicondyle, 121f, 199, 201 functions, 242 definition, 91
posterior shaft, 174 innervation, 251 term, usage, 91
Hyoid bone palpation, 251 terminology, avoidance, 91
lateral view of, 126f posterior view of, 250f Intercarpal joint, 47f
omohyoid, attachment, 289 pronunciation, 250 Intercostal group, 260-261. See also
sternohyoid, attachment, 289 reverse mover actions, 242 Internal intercostals; External
thyrohyoid, attachment, 289 spinal joints, crossing, 242 intercostals
Hyoid group, 284. See also Digastric; structures, relationship, 250 stretching exercise for, 442f
Geniohyoid; Mylohyoid; treatment considerations, 251 Intercostal spaces, 130f
Omohyoid; Sternohyoid; Iliopsoas. See Iliacus; Psoas major Intermediate tendon, 289
Sternothyroid; Stylohyoid; Iliotibial band (ITB), 356 Intermuscular septa, 93b
Thyrohyoid friction syndrome, 357 Internal abdominal oblique, 268–272. See
actions, 284–287, 286 pain caused by, 375 also Abdominal wall muscles
anterior belly, 284 Index finger, 219 actions, 270
attachments, 286 Inferior, 2 anterior views of, 269f
innervation, 286 Inferior frontal bone, 314 attachments, 270
mandible movement, involvement, 286 Inferior gemellus, 350–354. See also Deep derivation, 270
posterior belly, 284 lateral rotator group functions, 242
stretching exercise for, 438f actions, 352 innervation, 271
Hyoid muscle group, anterior view of, attachments, 352 lateral views of, 269f
284f–285f cautionary note, 354 palpation, 271, 271f
Hyperextension, 10 derivation, 351 pronunciation, 268
Hyperlordosis, 363 functions, 339–340 reverse mover actions, 242
Hypothenar eminence group, 226–228. innervation, 352 spinal joints, crossing, 242
See also Abductor digiti minimi palpation, 353, 353f structures, relationship, 268
manus; Flexor digiti minimi posterior views of, 351f treatment considerations, 272
manus; Opponens digiti minimi pronunciation, 350 Internal ilium, 361
actions, 227 reverse mover actions, 339–340 Internal intercostals, 260–261
anterior views of, 226f structures, relationship, 350 actions, 261
attachments, 227 treatment considerations, 354 attachments, 261
derivation, 227 Infrahyoid muscles, 288–290. See also derivation, 260
functions, 182–183 Omohyoid; Sternohyoid; functions, 242
innervation, 227 Sternothyroid; Thyrohyoid innervation, 261
palpation, 227–228 actions, 290 palpation, 261, 261f
pronunciation, 226 anterior views of, 288f–289f posterior view of, 260f
stretching exercise for, 441f attachments, 289 pronunciation, 260
structures, relationship, 226 derivation, 289 reverse mover actions, 242
treatment considerations, 228 functions, 242 structures, relationship, 260
innervation, 290 treatment considerations, 261
palpation, 290, 290f Internal pterygoid, 308
I pronunciation, 288 Interphalangeal (IP) joint, 20f, 38, 38f,
Iliac crest, 132f reverse mover actions, 242 183
Iliacus (iliopsoas), 360–363 structures, relationship, 288 Interspinales, 254–255
actions, 361 treatment considerations, 290 attachments, 255
anterior views of, 360f Infraspinatus, 162–165. See also Rotator cuff derivation, 254
attachments, 361 group functions, 242
460 Index
Interspinales—cont'd Intrinsic foot—plantar layer III—cont'd Lateral pterygoid, 306–308. See also
innervation, 255 actions, 425 Pterygoid group
palpation, 255 attachments, 425 actions, 307
posterior view of, 254f derivation, 425 attachments, 307
pronunciation, 254 innervation, 425 derivation, 306
reverse mover actions, 242 palpation, 425–426, 426f functions, 300
structures, relationship, 254 plantar views of, 424f innervation, 307
treatment considerations, 255 pronunciation, 424 lateral view of, 306f
Intertransversarii, 254–255 structures, relationship, 424 palpation, 307–308, 307f
actions, 255 treatment considerations, 426 posterior view of, 306f
attachments, 255 Intrinsic foot—plantar layer IV, 428–430. pronunciation, 306
derivation, 254 See also Dorsal interossei pedis; reverse mover actions, 300
functions, 242 Plantar interossei stretching exercise for, 439f
innervation, 255 actions, 429 structures, relationship, 306
palpation, 255 attachments, 429 treatment considerations, 308
pronunciation, 254 derivation, 429 Lateral rotation, 9
reverse mover actions, 242 dorsal view of, 428f Lateral tibial condyle, 135f
structures, relationship, 254 innervation, 429 Lateral tilt, 10
treatment considerations, 255 palpation, 429–430, 429f–430f Latissimus dorsi, 158–161
Intrinsic foot—dorsal surface, 416–417. See plantar view of, 428f actions, 159
also Extensor digitorum brevis; pronunciation, 428 attachments, 159
Extensor hallucis brevis structures, relationship, 428 derivation, 159
actions, 417 treatment considerations, 430 functions, 141–142
attachments, 416–417 Inversion, 10 GH joint, crossing, 141–142
derivation, 416 IP. See Interphalangeal innervation, 159
dorsal views of, 416f Ipsilateral rotator, 9 palpation, 159–160
innervation, 417 Ischial tuberosity, 133f, 352 pelvic attachments, 161
palpation, 417, 417f Isometric contractions, 92 posterior view of, 158f
pronunciation, 416 ITB. See Iliotibial band pronunciation, 158
structures, relationship, 416 reverse mover actions, 141–142
treatment considerations, 417 spinal attachments, 161
J
Intrinsic foot—plantar layer I, 418–421. stretching exercise for, 436f, 442f
See also Abductor digiti minimi Joint(s), 41, 44–45 structures, relationship, 158
pedis; Abductor hallucis; Flexor definition, 41 treatment considerations, 161
digitorum brevis functional classification, 41, 44–45 Left clavicle, 13f
actions, 419 structural classification, 41 Left interspinales, 254f
attachments, 419 types, structural illustration, 44f Left lateral flexion, 9
derivation, 419 upper trapezius, crossing, 147 Left pelvis, elevation (anterior views),
innervation, 419 Joint action 26f–28f
palpation, 419–420, 420f atlas, 11–38 Left rotation, 9
plantar views of, 418f impact, 9b Left scapula, 12f
pronunciation, 418 mover, occurrence, 88–89 Leg. See also Right leg
structures, relationship, 418 anterolateral view of, 135f
treatment considerations, 421 knee joint
K
Intrinsic foot—plantar layer II, 422–423. See flexion/extension, lateral views of,
also Lumbricals pedis; Quadratus Kinesiology, 2b 35f
plantae Knee joint lateral/medial rotation, anterior views
actions, 423 flexion/extension, lateral views of, 35f of, 35f
attachments, 423 lateral/medial rotation, anterior views Lengthening contraction, 92
derivation, 423 of, 35f Levator anguli oris, 322–334
innervation, 423 actions, 326
palpation, 423 anterior views of, 323f, 328f
L
plantar views of, 422f attachments, 326
pronunciation, 422 Lateral, 2, 307 derivation, 325
structures, relationship, 422 Lateral deviation, 9 function, 300
treatment considerations, 423 Lateral epicondylitis, 177, 213, 215, 217 innervation, 330
Intrinsic foot—plantar layer III, 424–426. Lateral epicondylosis, 177, 213, 215, 217 palpation, 331, 331f
See also Adductor hallucis; Flexor Lateral femoral condyles, 135f, 405 pronunciation, 322
digiti minimi pedis; Flexor Lateral hamstrings, 378 structures, relationship, 322
hallucis brevis Lateral malleolus, 137f treatment considerations, 334
Index 461
Levator labii superioris (LLS), 322–334 Levatores costarum—cont'd Longus colli—cont'd

actions, 326 innervation, 262 pronunciation, 293
anterior view of, 322f, 327f palpation, 262 reverse mover actions, 242
attachments, 326 posterior view of, 262f stretching exercise for, 438f
derivation, 325 pronunciation, 262 structures, relationship, 292
function, 300 reverse mover actions, 242 superior oblique part, 292
innervation, 330 structures, relationship, 262 treatment considerations, 295
palpation, 330, 330f Levatores costarum breves, 262 vertical part, 292
pronunciation, 322 Levatores costarum longi, 262 Low back, 258–259
structures, relationship, 322 Lips, 326 Lower extremities, 30–39
treatment considerations, 334 Lister's tubercle, 122f bony palpation, 131f–139f
Levator labii superioris alaeque nasi Little finger illustration, 3f–4f
(LLSAN), 322–334 fifth metacarpal, 227 reverse actions, commonness, 90
actions, 326 proximal phalanx, 227 Lower face, 326
anterior views of, 322f, 327f L1-L4, transverse processes, 258 Lower lip, 326
attachments, 326 LLS. See Levator labii superioris Lower trapezius, 147
derivation, 325 LLSAN. See Levator labii superioris alaeque Lumbosacral (LS) joint
function, 300 nasi motion, 26f–28f
innervation, 330 Location terminology, 2–5 absence, 32f–34f
palpation, 330, 330f Longissimus, 250–251. See also Erector posterior/anterior tilt, lateral views of,
pronunciation, 322 spinae group 26f–28f
structures, relationship, 322 actions, 242, 251 rotation, 26f–28f
treatment considerations, 334 attachments, 251 Lumbricals manus, 232–236. See also Central
Levator palpebrae superioris, 314–316 derivation, 250 compartment group
actions, 315 functions, 242 actions, 233
anterior view of, 315f innervation, 251 anterior view of, 232f
attachments, 314 palpation, 251 attachments, 233
derivation, 314 posterior view of, 250f derivation, 233
function, 300 pronunciation, 250 functions, 182–183
innervation, 315 reverse mover actions, 242 innervation, 234
lateral view of, 314f spinal joints, crossing, 242 palpation, 234
palpation, 316, 316f structures, relationship, 250 posterior view of, 232f
pronunciation, 314 treatment considerations, 251 pronunciation, 232
structures, relationship, 314 Longitudinal muscles, 95f reverse mover actions, 182–183
treatment considerations, 316 Longus capitis, 292–295. See also stretching exercise for, 441f
Levator scapulae, 150–151 Prevertebral group structures, relationship, 232
actions, 150 actions, 294 treatment considerations, 236
atlas, transverse process, 150 anterior views of, 292f Lumbricals pedis, 422–423. See also Intrinsic
attachments, 150 attachments, 293 foot—plantar layer II
C1-C4, transverse processes, 150 cautionary notes, 294, 295 actions, 423
cervical spine, crossing, 150 derivation, 293 attachments, 423
derivation, 150 functions, 242 derivation, 423
fibers, cervical spine wrapping, 150 innervation, 294 functions, 386
functions, 150–151 palpation, 294, 294f innervation, 423
innervation, 151 pronunciation, 292 MTP joint, crossing, 386
medial border, 150 reverse mover actions, 242 palpation, 423
palpation, 151 structures, relationship, 292 plantar view of, 422f
posterior view of, 150f treatment considerations, 295 pronunciation, 422
pronunciation, 150 Longus colli, 292–295. See also Prevertebral reverse mover actions, 386
reverse mover actions, 150 group structures, relationship, 422
scapula attachment, 150 actions, 293–294 treatment considerations, 423
spine attachment, 150 anterior views of, 292f
stretching exercise for, 435f attachments, 293
M
structures, relationship, 150 cautionary notes, 294, 295
treatment considerations, 151 derivation, 293 Mandible
Levatores costarum, 262 functions, 242 angle of, 124f
actions, 262 inferior oblique part, 292 body of, 124f
attachments, 262 innervation, 294 condyle of, 125f
derivation, 262 neck joints, crossing, 242 coronoid process, 304
functions, 242 palpation, 294, 294f depression/elevation, lateral views of, 29f
462 Index
Mandible—cont'd Mentalis—cont'd Muscle(s)—cont'd

depressor labii inferioris, attachment, lateral view of, 324f contraction—cont'd
326 palpation, 332, 333f defining, 87–90
inner surface, 286 pronunciation, 322 pulling force, 94
internal surface, 307 structures, relationship, 322 co-ordering, 87b
mentalis, attachment, 326 treatment considerations, 334 cross-bridges, 94f
mylohyoid, attachment, 286 Metacarpophalangeal (MCP) joints cross-section, 93f
protraction/retraction, lateral views of, extensor digiti minimi, crossing, 183 fibers, 93–94
29f extensor digitorum, crossing, 183 function, 87, 92
ramus of, 125f finger movement, 183 learning, 94, 96–98
right/left lateral deviation, anterior views muscles, crossing, 183 motion, causing, 89f
of, 30f reverse actions, 183 movement, 87b
temporomandibular joints, 29 Metatarsal, 138f palpation guidelines, 104–115
Masseter, 304–305 Metatarsophalangeal (MTP) joints, 38, 38f pulling forces, 87
actions, 305 Middle anterior fibula, 396 roles of, 92
attachments, 304–305 Middle posterior tibia, 411 standard mover actions, 89
deep layer, 304 Middle scalene, 282–283. See also Scalene system function, 90–91
derivation, 304 group Muscle actions, 98
functions, 300 actions, 283 Muscle attachment
innervation, 305 anterior view of, 282f atlas of, 48–85, 73f
lateral views of, 304 attachments, 282–283 bones/joints, 88b
layers, division, 304 cautionary note, 283 illustration, 88f
palpation, 305, 305f derivation, 282 joint, crossing, 88–89
pronunciation, 304 functions, 242 memorization, 94
reverse mover actions, 300 innervation, 283 naming, 91
structures, relationship, 304 palpation, 283 scenarios, 89f
superficial layer, 304 pronunciation, 282 Muscle attachment sites
treatment considerations, 305 reverse mover actions, 242 anterior views of, 49f, 53f, 61f, 65f, 69f,
MCP. See Metacarpophalangeal structures, relationship, 282 75f, 79f
Medial, 2 treatment considerations, 283 dorsal views of, 59f, 83f
Medial epicondylitis, 201, 203, 209 Middle trapezius, 147 lateral view of, 71f
Medial epicondylosis, 201, 203, 209 Mobile attachment, 88–89 palmar view of, 57f
Medial femoral condyles, 135f, 405 Mouth, 322–324 plantar view of, 85f
Medial foot, 391 angle, 326 posterior views of, 51f, 55f, 63f, 67f, 77f,
Medial hamstrings, 378 Movement terminology, 8–10 81f
Medial malleolus, 137f Mover, 88–89 Muscles of facial expression
Medial pterygoid, 306–308. See also shortening, 92 eye, 314–316. See Corrugator supercilii;
Pterygoid group Mover action, 89f Levator palpegrae superioris;
attachments, 307 Mover muscle, 92b Orbicularis oculi
deep head, 308 MTP. See Metatarsophalangeal mouth, 322–334. See Buccinator;
derivation, 307 Multifidus, 252–253. See also Depressor anguli oris; Depressor
functions, 300 Transversospinalis group labii inferioris; Levator anguli
innervation, 307 actions, 253 oris; Levator labii superioris;
palpation, 308, 308f attachments, 253 Levator labii superioris alaeque
pronunciation, 306 derivation, 252 nasi; Mentalis; Orbicularis oris;
stretching exercise for, 439f functions, 242 Platysma; Risorius; Zygomaticus
structures, relationship, 306 innervation, 253 major; Zygomaticus minor
superficial head, 308 palpation, 253 nose, 318–321. See Depressor septi nasi;
treatment considerations, 308 posterior view of, 252f Nasalis; Procerus
Medial rotation, 9 pronunciation, 252 Muscles of the Scalp, 310–312. See
Medial tibial condyle, 135f reverse mover actions, 242 Auricularis anterior; Auricularis
Medial tilt, 10 spinal joints, crossing, 242 posterior; Auricularis
Median nerve, 169, 209 structures, relationship, 252 superior; Occipitofrontalis;
Mentalis, 322–334 treatment considerations, 253 Temporoparietalis
actions, 326 Multipennate muscle, 96f Musculocutaneous nerve, 169
anterior view of, 329f Muscle(s). See also specific muscle Musculoskeletal function, pulling force
attachments, 326 cells, 93 (importance), 87–88
derivation, 325 components, 93f Mylohyoid, 284–287. See also Suprahyoid
function, 300 concentric contraction, 89f muscles
innervation, 330 contraction, 91–92 actions, 246
Index 463
Mylohyoid—cont'd Neck motions—cont'd Obturator internus, 350–354. See also Deep

anterior views of, 285f oblique plane, 7f lateral rotator group
attachments, 286 sagittal plane, 7f actions, 352
derivation, 285 transverse plane, 7f attachments, 352
functions, 242 Nonaxial joints, 45, 47f cautionary note, 354
innervation, 286 Nose, 318–321 derivation, 351
lateral views of, 285f cartilage, 318 functions, 339–340
mandible, attachment, 286 upper lip, relationship, 326 innervation, 352
palpation, 286–287 Nostril, 319 palpation, 353, 353f
pronunciation, 284 Nuchal ligament, 146 posterior view of, 351f
reverse mover actions, 242 pronunciation, 350
structures, relationship, 284 reverse mover actions, 339–340
O
treatment considerations, 287 structures, relationship, 350
Myofibrils, 93, 93f Oblique planes Occipital bone, 274
Myosin, 94, 94f example, 6f Occipitalis, 311
head/neck, 7f Occipitofrontalis (epicranius component),
motion, 8f 310–312
N Obliquus, 277 actions, 311
Nasal bone, 318 Obliquus capitis inferior, 278–278. See also attachments, 311
Nasalis, 318–321 Suboccipital group derivation, 311
actions, 319 actions, 277 function, 300
anterior views of, 318f, 319f attachments, 277 innervation, 311
attachments, 318 derivation, 277 lateral view of, 310
derivation, 318 functions, 242 palpation, 312, 312f
function, 300 innervation, 277 pronunciation, 310
innervation, 319 palpation, 278 structures, relationship, 310
palpation, 320, 320f posterior view of, 276 treatment considerations, 313
pronunciation, 318 pronunciation, 276 Olecranon process, 121f, 174
structures, relationship, 318 reverse mover actions, 242 Omohyoid, 288–290. See also Infrahyoid
treatment considerations, 321 spinous process, attachment, 277 muscles
Navicular tuberosity, 138f structures, relationship, 276 actions, 290
Neck treatment considerations, 278 anterior view of, 289f
anterior view Obliquus capitis superior, 278–278. See also attachments, 289
intermediate/deep views of, 248 Suboccipital group derivation, 289
superficial view of, 247 actions, 277 functions, 242
bones atlas, horizontal movement, 277 inferior belly, 289
anterior view of, 60f attachments, 277 innervation, 290
posterior view of, 62f derivation, 277 palpation, 290
bony landmarks functions, 242 pronunciation, 289
anterior view of, 60f innervation, 277 reverse mover actions, 242
posterior view of, 62f palpation, 278 structures, relationship, 288
C5 vertebral level, cross-section posterior view of, 276f superior belly, 289
cervical spinal joints, 23 pronunciation, 277 treatment considerations, 290
flexion/extension, sagittal plane (lateral reverse mover actions, 242 Opponens digiti minimi, 226–228
views), 23f structures, relationship, 276 actions, 227
lateral view of, 126f treatment considerations, 278 attachments, 227
left/right lateral flexion, frontal plane Obturator, 351 derivation, 227
(posterior views), 23f Obturator externus, 350–354. See also Deep functions, 182–183
levator scapulae, relationship, 150 lateral rotator group innervation, 227
muscles actions, 352 palpation, 227–228
attachment sites, 61f, 63f attachments, 352 pronunciation, 227
right lateral views of, 249f cautionary note, 354 reverse mover actions, 182–183
posterior triangle, 146–147, 281, derivation, 351 stretching exercise for, 441f
282–283, 289 functions, 339–340 structures, relationship, 226
region, muscles (right lateral view), innervation, 352 treatment considerations, 229
145 palpation, 353, 353f Opponens digiti minimi pedis, 426
spinal joints, 23f posterior view of, 351f Opponens hallucis, 426
sternocleidomastoid (SCM), 280–281 pronunciation, 350 Opponens pollicis, 222–224. See also Thenar
Neck motions reverse mover actions, 339–340 eminence group
frontal plane, 7f structures, relationship, 350 actions, 223
464 Index
Opponens pollicis—cont'd Palmaris brevis—cont'd Palpation—cont'd

anterior view of, 222f anterior view of, 230f flexor digitorum brevis, 419–420
attachments, 223 attachments, 230 flexor digitorum longus, 412–413
derivation, 223 derivation, 230 flexor digitorum profundus, 208
functions, 182 function, 182–183 flexor digitorum superficialis, 208
innervation, 223 innervation, 231 flexor hallucis brevis, 425–426
palpation, 223–224 palpation, 231 flexor hallucis longus, 413
pronunciation, 222 pronunciation, 230 flexor pollicis brevis, 223–224
reverse mover actions, 182–183 reverse mover actions, 182–183 flexor pollicis longus, 208
structures, relationship, 222 structures, relationship, 230 gastrocnemius, 405
treatment considerations, 224 Palmaris longus, 198–201. See also Wrist geniohyoid, 285
Opposite-side nasalis muscle, 318 flexor group. gluteus maximus, 347–348
Opposition, 10 actions, 199 gluteus medius, 348
Orbicularis oculi, 314–316 anterior view of, 198f gluteus minimus, 348
actions, 315 attachments, 199 gracilis, 368–369
anterior view of, 314f derivation, 199 guidelines for, 104–115
anterolateral view of, 315f functions, 182 iliacus, 361–362
attachments, 314 innervation, 199 iliocostalis, 251
derivation, 314 palpation, 200 inferior gemellus, 353
function, 300 pronunciation, 198 infraspinatus, 163–165
innervation, 315 reverse mover actions, 182 internal abdominal oblique, 271
palpation, 315, 326f structures, relationship, 198 internal intercostals, 261
pronunciation, 314 treatment considerations, 201 interspinales, 255
structures, relationship, 314 Palpation intertransversarii, 255
treatment considerations, 316 axial body, 124f–131f lateral pterygoid, 307–308
Orbicularis oris, 322–334 brachialis, 172–173 latissimus dorsi, 159–160
actions, 326 brachioradialis, 205 levator anguli oris, 331
anterior views of, 325f, 329f buccinator, 332 levator labii superioris, 330
attachments, 326 coracobrachialis, 169 levator palpebrae superioris, 316
derivation, 325 corrugator supercilii, 316 levator scapulae, 151
function, 300 deltoid, 167 levatores costarum, 262
innervation, 330 depressor anguli oris, 331 longissimus, 251
palpation, 332, 333f depressor labii inferioris, 332 longus capitis, 294
pronunciation, 322 depressor septi nasi, 320–321 longus colli, 294
structures, relationship, 322 diaphragm, 266 lower extremities, 131f–139f
treatment considerations, 334 digastric, 286–287 lumbricals manus, 234
Origin dorsal interossei manus, 235 lumbricals pedis, 423
attachments, contrast, 91 dorsal interossei pedis, 429–430 masseter, 305
definition, 91 erector spinae group, 251 medial pterygoid, 308
terminology, avoidance, 91 extensor carpi radialis brevis, 212 mentalis, 332
terms, usage, 91 extensor carpi radialis longus, 212 middle scalene, 283
extensor carpi ulnaris, 212 multifidus, 253
extensor digiti minimi, 215 mylohyoid, 286–287
P
extensor digitorum, 215 nasalis, 320
Palmar, 4 extensor digitorum brevis, 417 obliquus capitis inferior, 278
Palmar interossei, 232–236. See also Central extensor digitorum longus, 398–399 obliquus capitis superior, 278
compartment group extensor hallucis brevis, 417 obturator externus, 353
actions, 233 extensor hallucis longus, 396–397 obturator internus, 353
anterior view of, 232f extensor indicis, 220 occipitofrontalis, 311
derivation, 233 extensor pollicis brevis, 220 omohyoid, 290
functions, 182–183 extensor pollicis longus, 220 opponens digiti minimi, 227–228
innervation, 234 external abdominal oblique, 271 opponens pollicis, 223–224
palpation, 235 external intercostals, 261 orbicularis oculi, 315
pronunciation, 232 fibularis brevis, 401 orbicularis oris, 332
reverse mover actions, 182–183 fibularis longus, 401 palmar interossei, 235
stretching exercise for, 441f fibularis tertius, 402 palmaris brevis, 231
structures, relationship, 232 flexor carpi radialis, 200 palmaris longus, 200
treatment considerations, 236 flexor carpi ulnaris, 200 pectineus, 368–369
Palmaris brevis, 230–231 flexor digiti minimi manus, 227–228 pectoralis major, 155–156
actions, 231 flexor digiti minimi pedis, 425–426 pectoralis minor, 155–156
Index 465
Palpation—cont'd Palpation—cont'd Pelvis—cont'd

piriformis, 353 zygomaticus major, 331 posterior/anterior tilt, 26f–28f, 32f–34f
plantar interossei, 429–430 zygomaticus minor, 330 right, 74f–77f
plantaris, 408–409 Panniculus carnosus, 334 rotation, anterior/superior views of,
platysma, 334 Paraspinal musculature, 250, 252 26f–28f, 32f–34f
popliteus, 414–415 Patella, 135f rotation, spine (relationship), 26f–28f
posterior scalene, 283 Pectineus, 366–368. See also Adductor group Pennate muscles, 96f
procerus, 320 actions, 368 Perimysium (perimysia), 93
pronator quadratus, 203 anterior views of, 366f–367f Pes anserine, 370, 380
pronator teres, 203 attachments, 368 Pes anserine tendon, 358
psoas major, 361–362 cautionary note, 370 Phalanges, sides, 430
psoas minor, 365 derivation, 367 PIP. See Proximal interphalangeal
quadratus femoris, 353 functions, 339–340 Piriformis, 350–354. See also Deep lateral
quadratus lumborum, 258–259 hip joint, crossing, 339–340 rotator group
quadratus plantae, 423 innervation, 368 actions, 352
rectus abdominis, 271 palpation, 369, 369f attachments, 352
rectus capitis anterior, 295 pronunciation, 366 cautionary note, 354
rectus capitis lateralis, 295 reverse mover actions, 339–340 derivation, 351
rectus capitis posterior major, 277–278 stretching exercise for, 445f functions, 339–340
rectus capitis posterior minor, 278 structures, relationship, 366 innervation, 352
rectus femoris, 374 treatment considerations, 363 palpation, 353, 353f
rhomboid muscles, 149 Pectoralis major, 154–156 posterior view of, 350f
risorius, 332 actions, 155 pronunciation, 350
rotatores, 253 anterior view of, 154f reverse mover actions, 339–340
sartorius, 358–359 attachments, 154 structures, relationship, 350
semimembranosus, 379–380 derivation, 154 syndrome, 354
semispinalis, 253 functions, 141–142 treatment considerations, 354
semitendinosus, 379–380 innervation, 155 Pisiform, 124f, 227
serratus anterior, 153 palpation, 155 Pivot joints, 41. See also Uniaxial joints
serratus posterior inferior, 257 pronunciation, 154 Planes, 5–7
serratus posterior superior, 257 reverse mover actions, 141–142 body parts, motion (examples), 7f
soleus, 405–406 stretching exercise for, 436f, 437f importance, 8
spinalis, 251 structures, relationship, 154 usage, 5
splenius capitis, 275 triangular-shaped muscle, 95f Plantar, 4
splenius cervicis, 275 Pectoralis minor, 154–156 Plantar interossei, 428–430. See also Intrinsic
sternocleidomastoid, 281 actions, 155 foot—plantar layer IV
sternohyoid, 290 anterior view of, 154f actions, 429
stylohyoid, 286–287 attachments, 154 attachments, 429
subcostales, 265 derivation, 154 derivation, 429
subscapularis, 163–165 functions, 141–142 dorsal view of, 428f
superior gemellus, 353 innervation, 155 functions, 386
supinator, 216–217 palpation, 155–156 innervation, 429
supraspinatus, 163–165 pronunciation, 154 MTP joint, crossing, 386
temporalis, 305 reverse mover actions, 141–142 palpation, 429
temporoparietalis, 312 scapula, attachment, 154 pronunciation, 428
tensor fasciae latae, 356–357 stretching exercise for, 437f reverse mover actions, 386
teres major, 159–161 structures, relationship, 154 stretching exercise for, 448f
teres minor, 163–165 syndrome, 156 structures, relationship, 428
thyrohyoid, 290 tightness, 156 structures, relationship, 428
tibialis anterior, 394–395 Pelvic bone Plantar layer I. See Intrinsic foot—plantar
tibialis posterior, 411–412 acetabulum (hip joint), 47f layer I
transversospinalis group, 253 external surface, 352 Plantar layer II. See Intrinsic foot—plantar
transversus abdominis, 272 Pelvis, 32–34 layer II
transversus thoracis, 265 anterior view of, 133f Plantar layer III. See Intrinsic foot—plantar
trapezius, 147 depression/elevation, anterior views of, layer III
triceps brachii, 175 32f–34f Plantar layer IV. See Intrinsic foot—plantar
upper extremity, 117f–124f inferolateral oblique view of, 131f layer IV
vastus intermedius, 374 lumbosacral joint, motion, 26f–28f Plantar interossei, 428–430
vastus lateralis, 374 motion, 32f–34f actions, 429
vastus medialis, 374 orientation, 32f–34f attachments, 429
466 Index
Plantar interossei—cont'd Posterior scalene—cont'd Pronator quadratus—cont'd

derivation, 429 functions, 242 functions, 182
functions, 386 innervation, 283 innervation, 203
innervation, 429 palpation, 283 palpation, 203
MTP joint, crossing, 386 pronunciation, 282 pronunciation, 202
palpation, 429–430 reverse mover actions, 242 rectangular-shaped muscle,
plantar view of, 428f structures, relationship, 282 demonstration, 95f
pronunciation, 428 treatment considerations, 283 reverse mover actions, 182
reverse mover actions, 386 Posterior shin splints, 413 structures, relationship, 202
structures, relationship, 428 Posterior superior iliac spine (PSIS), 132f treatment considerations, 203
Plantarflexion, 10 Posterior triangle, 146–147, 281 Pronator teres, 202–203
Plantaris, 408–409 Posterior trunk, 130f actions, 202
actions, 408 Posterior tubercle, of C1, 128f anterior view of, 202f
ankle joint, crossing, 386 Prevertebral group, 292–295. See also Longus attachments, 202
attachments, 408 capitis; Longus colli; Rectus capitis derivation, 202
derivation, 408 anterior; Rectus capitis lateralis functions, 182
functions, 386 actions, 293–294 innervation, 203
innervation, 408 anterior views of, 292f–293f palpation, 203
palpation, 408, 409f attachments, 293 pronunciation, 202
posterior view of, 408f cautionary notes, 294, 295 reverse mover actions, 182
pronunciation, 408 derivation, 293 stretching exercise for, 440f
reverse mover actions, 386 functions, 242 structures, relationship, 202
structures, relationship, 408 innervation, 294 syndrome, 203
treatment considerations, 409 palpation, 294–295, 294f treatment considerations, 203
Platysma, 322–334 pronunciation, 292 Protraction, 9
actions, 326 reverse mover actions, 242 Proximal, 2
anterior views of, 325f, 329f structures, relationship, 292 Proximal anterior fibula, 398
attachments, 326 treatment considerations, 295 Proximal anterior tibia, 394
derivation, 325 Procerus, 318–321 Proximal arm
function, 300 actions, 319 approach. See Distal forearm
innervation, 330 anterior views of, 318f, 319f distal forearm approach, 89f
palpation, 334 attachments, 318 Proximal attachment, 89–90
pronunciation, 322 derivation, 318 Proximal interphalangeal (PIP) joints
structures, relationship, 322 function, 300 extensor digitorum, crossing, 183
treatment considerations, 334 innervation, 319 fingers, movement, 183
Pocket muscles, 272 palpation, 320, 320f reverse actions, 183
Popliteus, 414–415 pronunciation, 318 Proximal posteromedial tibia, 414
actions, 414 structures, relationship, 318 PSIS. See Posterior superior iliac spine
attachments, 414 treatment considerations, 321 Psoas major (iliopsoas), 360–363
derivation, 414 Pronation actions, 361
functions, 386 cardinal plane components, 37f anterior views of, 360f
innervation, 414 definition of, 9 attachments, 361
palpation, 414, 415f mobile radius, 202 cautionary note, 363
posterior view of, 414f Pronator group, 202–203. See also Pronatus derivation, 361
pronunciation, 414 teres; Pronator quadratus functions, 339–340
reverse mover actions, 386 actions, 202 hip joint, crossing, 339–340
stretching exercise for, 447f anterior view of, 202f innervation, 361
structures, relationship, 414 attachments, 202 palpation, 361–362, 362f
treatment considerations, 415 derivation, 202 pronunciation, 360
Posterior, 2–4 functions, 182 reverse mover actions, 339–340
Posterior head, 370 innervation, 203 structures, relationship, 360
Posterior iliac crest, 159, 258 palpation, 203 treatment considerations, 363
Posterior proximal ulna, 176 pronunciation, 202 Psoas minor, 364–365
Posterior sacrum, 159 reverse mover actions, 182 actions, 365
Posterior scalene, 282–283. See also Scalene structures, relationship, 202 anterior view of, 364f
group treatment considerations, 203 attachments, 364
actions, 283 Pronator quadratus, 202–203 derivation, 364
anterior view of, 282f actions, 202–203 functions, 339–340
attachments, 283 anterior view of, 202f innervation, 365
cautionary note, 283 attachments, 202 palpation, 365
derivation, 282 derivation, 202 pronunciation, 364
Index 467
Psoas minor—cont'd Quadratus plantae—cont'd Rectus capitis anterior—cont'd

reverse mover actions, 339–340 innervation, 423 cautionary notes, 294, 295
structures, relationship, 364 palpation, 423 derivation, 293
treatment considerations, 365 plantar view of, 422f functions, 242
vertebral column, crossing, 339–340 pronunciation, 422 innervation, 294
Psoas minor syndrome, 365 reverse mover action notes, 386 palpation, 295
Pterygoid group, 306–308. See also Lateral structures, relationship, 422 pronunciation, 293
pterygoid; Medial pterygoid treatment considerations, 423 reverse mover actions, 242
actions, 307 Quadriceps femoris group (Quads), structures, relationship, 292
attachments, 307 372–375. See also Rectus femoris; treatment considerations, 295
derivation, 307 Vastus intermedius; Vastus Rectus capitis lateralis, 292–295. See also
innervation, 307 lateralis; Vastus medialis Prevertebral group
lateral views of, 306f actions, 374 actions, 294
palpation, 307–308, 307f–308f anterior views of, 372f–373f anterior view of, 293f
posterior views of, 306f attachments, 373 AOJ, crossing, 242
pronunciation, 306 derivation, 373 attachments, 293
structures, relationship, 306 functions, 339–340 cautionary notes, 294, 295
treatment considerations, 308 innervation, 374 derivation, 293
Pubic bone, 134f palpation, 374, 374f functions, 242
Pubic tubercle, 134f pronunciation, 372 innervation, 294
Pulling forces, 87, 94 structures, relationship, 372 palpation, 294f, 295
exertion, 87–88 treatment considerations, 375 pronunciation, 293
strength, 94f Quadriceps surae, 406 reverse mover actions, 242
Pull-up bar, 89–90 structures, relationship, 292
treatment considerations, 295
R Rectus capitis posterior major, 278–278. See
Q Radial, 4 also Suboccipital group
Quadratus femoris, 350–354. See also Deep Radial group, stretching exercise for, 440f actions, 277
lateral rotator group Radial head, 121f attachments, 277
actions, 352 Radial nerve, 175 derivation, 277
attachments, 352 Radial tuberosity, 170 functions, 242
cautionary note, 354 Radioulnar (RU) joints innervation, 277
derivation, 351 forearm, 17 joints, crossing, 242
functions, 339–340 function, overview of, 181–183 palpation, 277, 277f
innervation, 352 involvement, 204 posterior view of, 276f
palpation, 353, 353f overview of, 181–183 pronunciation, 276
posterior views of, 351f right forearm, pronation/supination, reverse mover actions, 242
pronunciation, 350 17f structures, relationship, 276
reverse mover actions, 339–340 structure, overview of, 181–183 treatment considerations, 278
stretching exercise for, 444f, 445f Radius, styloid process of, 122f Rectus capitis posterior minor, 278–278. See
structures, relationship, 350 Rectangular-shaped muscle, 95f also Suboccipital group
treatment considerations, 354 Rectus, 277 actions, 277
Quadratus lumborum (QL), 258–259 Rectus abdominis, 268–272. See also attachments, 277
actions, 258 Abdominal wall muscles derivation, 277
derivation, 258 actions, 270 functions, 242
functions, 242 anterior view of, 268f innervation, 277
innervation, 258 attachments, 270 palpation, 278, 278f
palpation, 258–259, 259f derivation, 270 posterior view of, 276f
posterior view of, 258f functions, 242 pronunciation, 276
pronunciation, 258 innervation, 271 reverse mover actions, 242
reverse mover actions, 242 palpation, 271 structures, relationship, 276
same-side pelvic elevation, 258 pronunciation, 270, 270f treatment considerations, 278
stretching exercise for, 442f reverse mover actions, 242 Rectus femoris, 372–375. See also Quadriceps
structures, relationship, 258 spinal joints, crossing, 242 femoris group
treatment considerations, 259 stretching exercise for, 443f actions, 374
Quadratus plantae, 422–423. See also structures, relationship, 272 anterior views of, 372f
Intrinsic foot—plantar layer II Rectus capitis anterior, 292–295. See also attachments, 373
actions, 423 Prevertebral group bipennate muscle, 96f
attachments, 423 actions, 294 derivation, 373
derivation, 423 anterior views of, 293f functions, 339–340
functions, 386 attachments, 293 innervation, 374
468 Index
Rectus femoris—cont'd Right arm Right foot

knee joint, crossing, 339–340 bones bones
palpation, 374, 374f anterior view of, 48f dorsal view of, 82f
pronunciation, 372 posterior view of, 50f plantar view of, 84f
reverse mover actions, 339–340 bony landmarks bony landmarks
structures, relationship, 372 anterior view of, 48f dorsal view of, 82f
treatment considerations, 375 posterior view of, 50f plantar view of, 84f
Reposition, 10 cross-sectional views of, 191f muscle attachment sites
Resistance force, 87–88 muscle attachment sites dorsal view of, 83f
Retraction, 9 anterior view of, 49f plantar view of, 85f
Reverse mover actions, 89f, 89–91 posterior view of, 51f plantar view
Rhomboid muscles, 148–149 Right articularis genus, 376f deep view of, 393f
actions, 149 Right auricularis muscles, 310f intermediate view of, 393f
attachments, 148 Right biceps brachii, 170f superficial fascial views of, 392f, 392f
contraction, 149 Right biceps femoris, 378f superficial muscular view of, 392f
derivation, 148 Right brachioradialis, 204f Right forearm
innervation, 149 Right buccinator, 324f bones
location, 148 Right central compartment group muscles, anterior view of, 52f
major, 148–149 232f posterior view of, 54f
minor, 148–149 Right clavicle bony landmarks
palpation, 149 depression, 13f anterior view of, 52f
posterior view of, 148f elevation, 13f posterior view of, 54f
pronunciation, 148 protraction, 13f muscle attachment sites
reverse mover actions, 142 retraction, 13f anterior view of, 53f
rhomboidal-shaped muscles, upward rotation, 13f posterior view of, 55f
demonstration, 95f Right corrugator supercilii, 314f pronation/supination, radioulnar joints,
serratus anterior, blending, 149 Right deep distal four group, 218f 17f
stretching exercise for, 435f Right depressor anguli oris, 323f transverse plane cross-sections, 191f
structures, relationship, 148 Right depressor labii inferioris, 324f Right gastrocnemius, 404f
treatment considerations, 149 Right depressor septi nasi, 318f Right geniohyoid, 285f
Rib cage, internal surfaces, 266 Right digastric, 284f Right gluteus maximus
Rib cage joint, muscles Right dorsal interossei manus, 232f lateral view of, 346f
anterior, 130f Right dorsal interossei pedis, 428f posterior view of, 346f
cartilage, 270 Right erector spinae group, 250f Right gluteus minimus, 346f
costal cartilages, 154 Right extensor carpi radialis brevis, 210f Right gracilis, 367f
elevation, 157 Right extensor carpi radialis longus, 210f Right hamstring group, 378f
function, overview of, 339–340 Right extensor carpi ulnaris, 210f Right hand
intercostal spaces, 261 Right extensor digiti minimi, 214f bones
overview of, 339–340 Right extensor digitorum, 214f dorsal view of, 58f
serratus posterior inferior, 257 Right extensor digitorum brevis, 416f palmar view of, 56f
serratus posterior superior, 257 Right extensor digitorum longus, 398f bony landmarks
structure, overview of, 339–340 Right extensor hallucis brevis, 416f dorsal view of, 58f
subclavius, attachment, 157 Right extensor hallucis longus, 396f palmar view of, 56f
Right abductor digiti minimi manus, 226f Right external abdominal oblique, muscle attachment sites
Right abductor digiti minimi pedis, 418f 268–269 dorsal view of, 59f
Right abductor hallucis, 418f Right external intercostals, 260f palmar view of, 57f
Right abductor pollicis brevis, 222f Right fibularis brevis, 400f Right hip joint
Right abductor pollicis longus, 218f Right fibularis longus, 400f deep views of, 342f, 344f
Right adductor brevis, 366f Right fibularis tertius, 400f elevation, 32f–34f
Right adductor hallucis, 418f Right flexor digiti minimi manus, 226f muscles
Right adductor longus, 366f Right flexor digiti minimi pedis, 424f anterior views of, 341f, 341f–342f
Right adductor magnus, 367f Right flexor digitorum brevis, 418f lateral view of, 345f
Right adductor pollicis, 232f Right flexor digitorum longus, 410f medial views of, 345f
Right anconeus, 176f Right flexor digitorum profundus, 206f posterior views of, 343–344
Right ankle joint, muscles Right flexor digitorum superficialis, 204f superficial view of, 345f
anterior view of, 387f Right flexor hallucis brevis, 424f Right hypothenar group, muscles, 226f
lateral views of, 390f, 390f Right flexor hallucis longus, 410f Right iliacus, 360f
medial views of, 390, 390f Right flexor pollicis brevis, 222f Right internal abdominal oblique,
posterior views if, 388f, 388f–389f Right flexor pollicis longus, 206f 268f–269f
Index 469
Right internal intercostals, 260f Right rotation, 9 Right tibialis posterior, 410f
Right interspinales, 254f Right rotatores, 252f Right transversus abdominis, 269f
Right lateral deviation/left lateral deviation, Right sartorius, 358f Right transversus thoracis, 264f
9 Right scapula Right trapezius, 146f
Right lateral flexion, 9 bones Right triceps brachii, 174f
Right lateral pterygoids, 306f anterior view of, 48f Right wrist
Right latissimus dorsi, 158f posterior view of, 50f extensor group, muscles (posterior view),
Right left lateral flexion, 9 bony landmarks 188f
Right leg anterior view of, 48f joint, superficial views of, 184f, 187f
bones posterior view of, 50f Right wrist joint, muscles
anterior view of, 78f depression, 11f anterior view
posterior view of, 80f elevation, 11f deep view of, 186f
bony landmark lateral tilt, 12f intermediate, 185f
anterior view of, 78f muscle attachment sites superficial, 184f
posterior view of, 80f anterior view of, 49f anterior views of, 184f–186f
compartments, transverse plane cross- posterior view of, 51f deep view of, 186f
section, 391 protraction, 11f intermediate view of, 185f
muscle attachment sites retraction, 11f lateral views of, 190f
anterior view of, 79f upward rotation, scapulocostal (ScC) medial views of, 189f
posterior view of, 81f joint, 12f posterior views of, 187f–188f,
muscles, transverse plane cross-section, upward tilt, 12f 187f–188f
391 Right semimembranosus, 378f intermediate/deep views of, 188f
Right levator anguli oris, 323f Right semitendinosus, 378f superficial, 187f
Right levator labii superioris, 322f Right serratus anterior, 152f superficial view of, 187f
Right levator labii superioris alaeque nasi, Right serratus posterior superior, 256f Right zygomaticus major, 323f
322 Right soleus, 404f Right zygomaticus minor, 323f
Right levator palpebrae superioris, 314f Right splenius capitis, 274f Risorius, 322–334
Right levatores costarum, 262f Right splenius cervicis, 274f actions, 326
Right longus capitis, 294f Right sternocleidomastoid, 280f anterior views of, 323f, 328f
Right longus colli, 293f Right sternohyoid, 288f attachments, 326
Right lumbricals manus, 232f Right sternothyroid, 289f derivation, 325
Right lumbricals pedis, 422f Right stylohyoid, 284f function, 300
Right mentalis, 324f Right subclavius, 157f innervation, 330
Right multifidus, 252f Right suboccipital group, 276f palpation, 332, 332f
Right nasalis, 318f Right subscapularis, 162f pronunciation, 332
Right obliquus capitis superior, 276f Right subtalar joint, muscles structures, relationship, 322
Right occipitofrontalis, 310f lateral views of, 390f, 390f treatment considerations, 334
Right omohyoid, 289f medial views of, 390f, 390f Rotator cuff group, 162–165. See also
Right opponens pollicis, 222f posterior view Infraspinatus; Subscapularis;
Right orbicularis oculi, 314f–315f intermediate/deep views of, 389f Teres minor
Right orbicularis oris, 324f superficial views of, 388f, 388f attachments, 163
Right palmar interossei, 232f Right supinator, 216f functions, 141–142
Right palmaris longus, 198f Right supraspinatus, 162f humerus movers, 162
Right pectineus, 366f–367f Right temporoparietalis, 310f innervation, 163
Right pectoralis major, 154f Right tensor fasciae latae, 356f treatment considerations, 165
Right pectoralis minor, 154f Right teres major, 158f views of, 162f
Right pelvis, 26f–28f, 32f–34f Right thenar group, 222f Rotatores, 252–253. See also
Right plantar interossei, 428f Right thigh Transversospinalis group
Right plantaris, 408f bones actions, 253
Right platysma, 325f anterior view of, 74f attachments, 253
Right popliteus, 414f posterior view of, 76f derivation, 252
Right procerus, 318f bony landmarks functions, 242
Right pronator quadratus, 202f anterior view of, 74f innervation, 253
Right pronator teres, 202f posterior view of, 76f palpation, 253
Right quadratus lumborum, 258f muscle attachment sites posterior view of, 252f
Right quadratus plantae, 422f anterior view of, 75f pronunciation, 252
Right rectus capitis posterior minor, 276f posterior view of, 77f reverse mover actions, 242
Right rhomboids major/minor, 148f Right thyrohyoid, 289f structures, relationship, 252
Right risorius, 323f Right tibialis anterior, 394f treatment considerations, 253
470 Index
Rounded shoulders, 149, 156 Scaphoid, 123f Semispinalis—cont'd

RU. See Radioulnar Scapula (scapulae) derivation, 252
Rubber band exercise, 98, 98b acromion process, 118f–119f functions, 242
coracoid process, 118f, 154, 170 innervation, 253
downward rotation, 148, 155 palpation, 253
S elevation/depression, nonaxial actions, posterior view of, 252f
Sacrospinalis group, 250 11f pronunciation, 252
Sacrum inferior angle of, 120f reverse mover actions, 242
inferolateral view of, 132f infraglenoid tubercle, 174 spinal joints, crossing, 242
piriformis (attachment), 352 infraspinous fossa, 163 stretching exercise for, 438f
Saddle joints, 44 lateral border of, 120f structures, relationship, 252
biaxial consideration, 46f levator scapulae, attachment, 150 treatment considerations, 253
example. See Biaxial saddle joint medial border, 148, 150 Semitendinosus, 378–380. See also
thumb, 45, 46f anterior surface, 152 Hamstring group
Sagittal plane medial border of, 119f actions, 379
example, 6f medial tilt, 148 attachments, 379
head/neck/forearm, motions (example), muscle attachment, 141 derivation, 379
7f posterolateral view of, 118f functions, 339–340
motion, occurrence, 8f protraction/retraction, nonaxial actions, innervation, 379
Same-side pelvic depression force, 347 11f knee joint, crossing, 339–340
Same-side pelvis elevation, QL (impact), 258 reverse action, 15 palpation, 379–380, 379f–380f
Sarcomeres, 93 rhomboid minor, attachment, 148 posterior views of, 378f
actin/myosin filaments composition, 94f scapulocostal joint, 11 pronunciation, 378
components, illustration, 94f shoulder joint, reverse action, 15 reverse mover actions, 339–340
composition, 93 spine, 119f, 146 structures, relationship, 378
impact, 94 superior angle of, 119f treatment considerations, 380
Sartorius, 358–359 superior lateral border, 163 Serratus anterior, 152–153
actions, 358 supraglenoid tubercle, 170 actions, 153
anterior view of, 358f supraspinous fossa, 163 attachments, 152
attachments, 358 tilt, capability, 146 derivation, 152
derivation, 358 tilt actions, scapulocostal (ScC) joint, 12f functions, 141–142
functions, 339–340 trapezius, attachment, 141–142 innervation, 153
hip joint, crossing, 339–340 upper trapezius, attachment, 141–142 lateral view of, 152f
innervation, 358 winging of, 153 palpation, 153
palpation, 358, 359f Scapulocostal (ScC) joint, 12f pronunciation, 152
pronunciation, 358 ScC. See Scapulocostal reverse mover actions, 141–142
reverse mover actions, 339–340 Sciatic nerve, 354 rhomboid muscles, blending, 149
strap muscle, demonstration, 95f Sciatica, 354 right, 152f
stretching exercise for, 445f SCM. See Sternocleidomastoid scapula
structures, relationship, 358 Second toe, MTP joint (fibular abduction), medial border, anterior surface, 152
treatment considerations, 359 38f relationship, 152–153
SC. See Sternoclavicular Semimembranosus, 378–380. See also winging of, 153
Scalene group, 282–283. See also Anterior Hamstring group serrated appearance, 152
scalene; Middle scalene; Posterior actions, 379 stretching exercise for, 437f
scalene attachments, 379 structures, relationship, 152
actions, 283 derivation, 378 treatment considerations, 153
anterior views of, 282f functions, 339–340 Serratus posterior inferior, 256–257
attachments, 282–283 innervation, 379 actions, 257
cautionary note, 283 knee joint, crossing, 339–340 attachments, 257
derivation, 282 palpation, 379–380, 379f–380f derivation, 256
functions, 242 posterior views of, 378f functions, 242
injury, 281, 283 pronunciation, 378 innervation, 257
innervation, 283 reverse mover actions, 339–340 palpation, 257
palpation, 283, 283f structures, relationship, 378 posterior view of, 256f
pronunciation, 282 treatment considerations, 380 pronunciation, 256
stretching exercise for, 438f Semispinalis, 252–253. See also reverse mover actions, 242
structures, relationship, 282 Transversospinalis group ribs, attachment, 257
treatment considerations, 283 actions, 253 structures, relationship, 256
Scalp, 310–312 attachments, 253 treatment considerations, 257
Index 471
Serratus posterior superior, 256–257 Spinal joints Splenius cervicis—cont'd

actions, 257 external abdominal oblique, crossing, 242 structures, relationship, 274
attachments, 257 internal abdominal oblique, crossing, 242 treatment considerations, 275
derivation, 256 longissimus, crossing, 242 Splenius group, 274–275. See also Splenius
functions, 242 multifidus, crossing, 242 capitis; Splenius cervicis
innervation, 257 rectus abdominis, crossing, 242 actions, 275
palpation, 257 thoracolumbar spine, motions, 24f–25f attachments, 274–275
posterior view of, 256f Spinal joints, muscles derivation, 274
pronunciation, 256 crossing, 242 functions, 242
reverse mover actions, 242 function, overview of, 242 innervation, 275
ribs, attachment, 257 overview of, 242 palpation, 275
structures, relationship, 256 structure, overview of, 242 posterior views of, 274
treatment considerations, 257 Spinalis, 250–251. See also Erector spinae pronunciation, 274
Sesamoid bone, 224, 236 group reverse mover actions, 242
Shin splints, 395, 413 actions, 251 stretching exercise for, 438f
Short leg, 349 attachments, 251 structures, relationship, 274
Short lower extremity, 349 derivation, 250 treatment considerations, 275
Shoulder girdle functions, 242–242 Stabilizers, 92
anatomic position, 144f innervation, 251 Standing, 90f
anteromedial view of, 117f palpation, 251, 251f Sternoclavicular (SC) joint, 117f
attachment, 141 posterior view of, 250f clavicle, 13
left side pronunciation, 250 right clavicle, 13f
depth, 144f reverse mover actions, 241–242 Sternocleidomastoid (SCM), 280–281. See
superficiality, 143f structures, relationship, 250 also Head; Neck
movement, 141 treatment considerations, 251 actions, 280
right side Spindle-shaped muscle, demonstration, 95f attachments, 280
depth, 143f Spine cautionary note, 281
superficiality, 144f atlantoaxial joint, 45f cranial attachment, fixation, 280–281
Shoulder girdle, muscles levator scapulae, attachment, 150 cutting, 144f
anterior view of, 144, 144f Spinous process derivation, 280
function of, 141–142 C2-C7, 128f functions, 242
posterior view of, 143 obliquus capitis inferior (attachment), injury, 281
right lateral views of, 145, 145f 277 innervation, 280
structure of, 141 of trunk, 131f joints, crossing, 242
Shoulder joint, 15 Splenius capitis, 274–275 lateral view of, 280f
SITS. See Supraspinatus infraspinatus teres actions, 275 occipital bone, superior attachment,
minor subscapularis atlanto-occipital joint, crossing, 242 280
Skeletal system, 41 attachments, 274–275 palpation, 281, 281f
Skeleton, 41 derivation, 274 pronunciation, 280
anterior view of, 42f functions, 242 reverse mover actions, 242
posterior view of, 43f innervation, 275 stretching exercise for, 438f
Sliding filament mechanism, 93–94 palpation, 275 structures, relationship, 280
Soleus, 404–406. See also Triceps surae posterior view of, 274f treatment considerations, 281
group pronunciation, 274 Sternohyoid, 288–290. See also Infrahyoid
actions, 405 reverse mover actions, 242 muscles
ankle joint, crossing, 386 stretching exercise for, 438f actions, 290
attachments, 405 structures, relationship, 274 anterior views of, 288f–289f
derivation, 404 treatment considerations, 275 attachments, 289
functions, 386 Splenius cervicis, 274–275 derivation, 289
innervation, 405 actions, 275 functions, 242
palpation, 405, 406f attachments, 275 innervation, 290
posterior view of, 404f cervical spine joints, crossing, 242 palpation, 290
pronunciation, 404 derivation, 274 pronunciation, 288
reverse mover actions, 386 functions, 242 reverse mover actions, 242
stretching exercise for, 446f innervation, 275 structures, relationship, 288
structures, relationship, 404 palpation, 275 treatment considerations, 290
treatment considerations, 406 posterior view of, 274f Sternothyroid, 288–290. See also Infrahyoid
Speed skaters' muscle, 349 pronunciation, 274 muscles
Sphenoid bone, 307 reverse mover actions, 242 actions, 290
472 Index
Sternothyroid—cont'd Subcostales—cont'd Superior gemellus—cont'd

anterior view of, 288f–289f reverse mover actions, 242 innervation, 352
attachments, 289 structures, relationship, 264 palpation, 353, 353f
derivation, 289 treatment considerations, 265 posterior view of, 350f
functions, 242 Subdeltoid bursa, 165 pronunciation, 350
innervation, 290 Suboccipital group, 276–278. See also reverse mover actions, 339–340
palpation, 290 Obliquus capitis inferior; structures, relationship, 350
pronunciation, 288 Obliquus capitis superior; Rectus treatment considerations, 354
reverse mover actions, 242 capitis posterior major; Rectus Supination, 9, 170
structures, relationship, 288 capitis posterior minor Supinator, 216–217
treatment considerations, 290 actions, 277 actions, 216
Sternum attachments, 277 attachments, 216
internal surfaces, 265 derivation, 277 cautionary note, 217
suprasternal notch of, 129f innervation, 277 derivation, 216
xiphoid process of, 129f palpation, 277–278 functions, 182
Stirrup muscles, 395, 402 posterior views of, 276 innervation, 216
Strap muscle, 95f pronunciation, 276 palpation, 216–217
Stretching atlas, 435–448 stretching exercise for, 438f posterior view of, 216f
Structural short leg, 349 structures, relationship, 276 pronunciation, 216
Stylohyoid, 284–287. See also Suprahyoid treatment considerations, 278 reverse mover actions, 182
muscles Subscapular bursa, 165 stretching exercise for, 440f
actions, 286 Subscapularis, 162f, 162–165. See also structures, relationship, 216
anterior view of, 284f Rotator cuff group treatment considerations, 217
attachments, 286 actions, 163 Suprahyoid muscles, 284–287. See also
derivation, 285 attachments, 163 Digastric; Geniohyoid; Mylohyoid;
functions, 242 derivation, 162 Stylohyoid
innervation, 286 functions, 141–142 actions, 286
lateral view of, 284f innervation, 163 anterior views of, 284f–285f
palpation, 286–287, 287f palpation, 164–165 attachments, 286
pronunciation, 285 pronunciation, 162 derivation, 285
reverse mover actions, 242 reverse mover actions, 141–142 functions, 242
structures, relationship, 284 stretching exercise for, 436f innervation, 286
treatment considerations, 287 structures, relationship, 162 lateral views of, 284f–285f
Styloid process Subtalar joint, foot, 37 palpation, 286–287, 286f–287f
of radius, 122f dorsiflexion/plantarflexion, sagittal pronunciation, 284
of ulna, 122f plane, 37f reverse mover actions, 242
Subacromial bursa, 165 lateral/medial rotation, transverse plane, structures, relationship, 284
Subclavius, 157 37f treatment considerations, 287
actions, 157 motions, 37f Supraspinatus, 162f, 162–165. See also
anterior view of, 157f Subtalar joint, muscles. See also Right Rotator cuff group
attachments, 157 subtalar joint actions, 163
derivation, 157 anterior view of, 387 attachments, 163
functions, 141–142 function, overview of, 386 derivation, 162
innervation, 157 lateral view of, 390, 390f functions, 141–142
pronunciation, 157 medial views of, 390f, 390f innervation, 163
reverse mover actions, 141–142 overview of, 385–386 palpation, 163–164
ribs, attachment, 157 posterior view reverse mover actions, 141–142
stretching exercise for, 437f intermediate/deep views of, 389f stretching exercise for, 436f
structures, relationship, 157 superficial view of, 388, 388f structures, relationship, 162
treatment considerations, 157 structure, overview of, 385–386 Supraspinatus infraspinatus teres minor
Subcostales, 264–265 Superficial, 4 subscapularis (SITS) muscles,
actions, 265 Superior, 2 162–165
anterior view of, 264f Superior chest, 326 Suprasternal notch of sternum, 129f
attachments, 264 Superior gemellus, 350–354. See also Deep Surae, 406
derivation, 264 lateral rotator group Sustentaculum tail of the calcaneus, 138f
functions, 242 actions, 352 Swayback, 363
innervation, 265 attachments, 352 Swimmer's muscle, 161
palpation, 265 cautionary note, 354 Synarthrotic joints, 41
posterior view of, 264f derivation, 351 Synovial biaxial joints, 44
pronunciation, 264 functions, 339–340 Synovial joints, 41, 44f, 44–45
Index 473
Tensor fasciae latae—cont'd Thumb—cont'd

T
innervation, 356 anterior views of, 20f
Tarsal joint, 37 lateral view of, 356f carpometacarpal (CMC) joint, 20
Temporal bone palpation, 356, 357f biaxial saddle joint, example, 46f
lateral view of, 125f pronunciation, 356 flexor pollicis brevis (crossing),
mastoid process, 274 reverse mover actions, 339–340 182–183
styloid process, 286 stretching exercise for, 444f extension, allowance, 46f
zygomatic arch/bone, 305 structures, relationship, 356 first carpometacarpal joint, actions, 20f
Temporalis, 304–305 treatment considerations, 357 first metacarpal, 223
actions, 305 Teres major, 158–161 flexion of, 46f
attachments, 304 actions, 159 interphalangeal joint, 20f
derivation, 304 anterior view of, 158f lateral views of, 20f
functions, 300 attachments, 159 proximal phalanx, 223
innervation, 305 derivation, 159 rotation motions, transverse plane, 46f
lateral views of, 304 functions, 141–142 saddle joint, 20f, 46f
palpation, 305, 305f innervation, 159 Thyrohyoid, 288–290. See also Infrahyoid
pronunciation, 304 palpation, 161 muscles
reverse mover actions, 300 posterior view of, 158f actions, 290
stretching exercise for, 438f pronunciation, 158 anterior views of, 288f–289f
structures, relationship, 304 reverse mover actions, 141–142 attachments, 289
treatment considerations, 305 stretching exercise for, 436f derivation, 289
Temporalis fascia, 305 structures, relationship, 158 functions, 242
Temporomandibular joint syndrome, 305, treatment considerations, 161 innervation, 290
308 Teres minor, 162f, 162–165 palpation, 290
Temporomandibular joint (TMJ), mandible, actions, 163 pronunciation, 288
29f attachments, 163 reverse mover actions, 242
depression, 29f derivation, 162 structures, relationship, 288
elevation, lateral view of, 29f functions, 141–142 treatment considerations, 290
protraction, lateral views of, 29f innervation, 163 Thyroid cartilage, 127f, 289
retraction, lateral views of, 29f palpation, 164–165 Tibia, 379
right/left lateral deviation, anterior views pronunciation, 162 Tibial, 4
of, 30f reverse mover actions, 141–142 Tibial abduction, 430
Temporomandibular joint (TMJ), muscles stretching exercise for, 436f Tibial condyles, 135f
function of, 241–242 structures, relationship, 162 Tibial shaft, 136f
overview of, 241–242 treatment considerations, 165 Tibial tuberosity, 136f, 373
structure of, 241–242 Terminology, 2, 4, 9–10 Tibialis anterior, 394–395
Temporoparietalis (epicranius component), Texting thumb, 224 actions, 394
310–312 TFL. See Tensor fasciae latae ankle joint, crossing, 386
actions, 311 Thenar eminence group, 222–224. See also anterior view of, 394f
attachments, 311 Abductor pollicis brevis; Flexor attachments, 394
derivation, 311 pollicis brevis; Opponeus pollicis derivation, 394
function, 300 attachments, 223 functions, 386
innervation, 311 deep view of, 222f innervation, 394
lateral view of, 310f functions, 182–183 palpation, 394, 395f
palpation, 312, 312f innervation, 223 pronunciation, 394
pronunciation, 310 muscles, 222f reverse mover actions, 386
structures, relationship, 310 stretching exercise for, 441f stretching exercise for, 445f
treatment considerations, 313 Thigh, 30–31 structures, relationship, 394
Tendinitis, 167 abduction/adduction, anterior views of, treatment considerations, 395
Tendinous inscriptions, 272 31f Tibialis posterior, 410–413. See also Tom,
Tendons, 93 flexion/extension, lateral views of, 30f Dick, and Harry group
Tennis elbow, 177, 213, 215, 217 lateral/medial rotation, anterior views actions, 411
Tenosynovitis, 220 of, 31f ankle joint, crossing, 386
Tension headache, 147 motions, 30f–31f attachments, 411
Tensor fasciae latae (TFL), 356–357 orientation, 32f–34f derivation, 411
actions, 356 Thoracic outlet syndrome, 157, 283 functions, 386
attachments, 356 Thoracolumbar spine, 24f–25f innervation, 411
derivation, 356 Thumb location, 410
functions, 339–340 abduction, 46f, 223 palpation, 411, 412f
hip joint, crossing, 339–340 adduction, 46f posterior view of, 410f
474 Index
Tibialis posterior—cont'd Transversus abdominis—cont'd Triceps surae group—cont'd

pronunciation, 410 palpation, 272 innervation, 405
reverse mover actions, 386 pronunciation, 270 palpation, 405, 405f–406f
stretching exercise for, 447f reverse mover actions, 242 posterior views of, 404f
structures, relationship, 410 structures, relationship, 268 pronunciation, 404
treatment considerations, 413 treatment considerations, 272 structures, relationship, 404
Tibiofemoral joint, motions, 35f Transversus thoracis, 264–265 treatment considerations, 406
T7-L5, 159 actions, 265 Trunk
TMJ. See Temporomandibular joint anterior view of, 264f arm GH joint, reverse actions, 15f–16f
Toes attachments, 264–265 bones
dorsal surface, 398 derivation, 264 anterior view of, 64f
extrinsic muscles of, 385–386 functions, 242 posterior view of, 66f
intrinsic muscles of, 385–386 innervation, 265 bony landmarks
metatarsal heads of, 139f palpation, 265 anterior view of, 64f
metatarsophalangeal/interphalangeal pronunciation, 264 posterior view of, 66f
joints of, 38, 38f reverse mover actions, 242 flexion/extension, lateral views of,
plantar surface, 411 structures, relationship, 264 24f–25f
Tom, Dick, and Harry group, 410–413. See treatment considerations, 265 GH joint, neutral position, 15f–16f
also Flexor digitorum longus; Trapezium, 123f lateral view of, 249f
Flexor hallucis longus; Tibialis Trapezius, 146–147 posterior, 130f
posterior actions, 146–147 regions, right lateral views of, 249f
actions, 411 attachments, 146 right/left lateral flexion, frontal plane
attachments, 411 derivation, 146 (anterior views), 24f–25f
derivation, 411 eccentric antagonist functions. See Lower right/left rotation, transverse plane
innervation, 411 trapezius; Middle trapezius; (anterior views), 24f–25f
palpation, 411–413, 412f–413f Upper trapezius shoulder joint, reverse action, 15
posterior views of, 410 functional parts, 146 spinous processes of, 131f
pronunciation, 410 functions, 141–142 superolateral view of, 129f
structures, relationship, 410 innervation, 147 thoracolumbar spine, spinal joints
treatment considerations, 413 muscles, entirety, 146 (motions), 24f–25f
Transverse plane palpation, 147 transverse processes of, 131f
examples, 6f posterior view of, 146f Trunk, muscles
head/neck/arm, motions (example), 7f pronunciation, 146 anterior views
motion, occurrence, 8f reverse mover actions, 142 deeper views of, 246f
Transverse process, 127f, 131f, 253 stabilization functions, 147 superficial/intermediate views of,
Transversospinalis group, 252–253. See stretching exercise for, 435f 245f
also Multifidus; Rotatores; structures, relationship, 146 attachment sites
Semispinalis Triangular-shaped muscle, 95f anterior view of, 65f
actions, 253 Triaxial ball-and-socket joint, 47f posterior view of, 67f
attachments, 253 Triaxial joints, 45 posterior views
derivation, 252 Triceps brachii, 174–175 deeper views of, 244f
functions, 242 actions, 175 superficial/intermediate views of,
innervation, 253 attachments, 174 243f
name, indication, 252 derivation, 174 superficial view of, 243f
palpation, 253, 253f elbow joint, crossing, 141–142 Tubercles
posterior view of, 252f functions, 141–142 Lister's, 122f
pronunciation, 252 innervation, 175 pubic, 134f
reverse mover actions, 242 palpation, 175 of scaphoid, 123f
spinal joints, crossing, 242 pronunciation, 174 of trapezium, 123f
stretching exercise for, 442f reverse mover actions, 141–142
structures, relationship, 252 stretching exercise for, 439f
U
treatment considerations, 253 structures, relationship, 174
Transversus abdominis, 268–272. See also treatment considerations, 175 Ulna
Anterior abdominal wall muscles views of, 174f olecranon process of, 121f, 174
actions, 270–271 Triceps surae, 404, 406 styloid process of, 122f
anterior view of, 269f Triceps surae group, 404–406. See also Ulnar, 4
attachments, 270 Gastrocnemius; Soleus Ulnar nerve, 169
derivation, 270 actions, 405 Uniaxial joints, 41, 44f–45f
functions, 242 attachments, 405 Unipennate muscle, 96f
innervation, 271 derivation, 404 Upper body, orientation (change), 32f–34f
474
Index 475
Upper chest, anterior view Vastus medialis—cont'd Wrist joint—cont'd

intermediate/deep views of, 248f anterior views of, 373f extensor carpi radialis longus, crossing,
superficial view of, 247 attachments, 373 182
Upper extremities, 3f–4f derivation, 373 extensor carpi ulnaris, crossing, 182
bony landmarks, atlas, 48–59 functions, 339–340 flexor carpi ulnaris, crossing, 182
bony palpation of, 117f–124f innervation, 374 function, overview of, 182
joint action, 11–20 knee joint, crossing, 339–340 intercarpal, 47f
muscle attachment, atlas, 48–59 linea aspera, 373 lateral view of, 122f
Upper lip palpation, 374, 374f linear gliding motion, 47f
elevators, 326 pronunciation, 372 motions, 18f
nose, relationship, 326 reverse mover actions, 339–340 overview of, 182
Upper neck joints, 242 structures, relationship, 372 stabilization, 213
Upper spine treatment considerations, 375 structure, overview of, 182
contralateral rotation, reverse action, 242 Ventral, 2, 4 Wrist joint, muscles. See also Right wrist
flexion/extension, reverse action, 242 Vertebra prominens, 128f joint
Upper trapezius, 147 Vertical fiber direction, 97–98 anterior views of, 184f–186f
acromion process pulling, 146–147 VML. See Vastus medialis longus deep view of, 186f
scapula attachment, 146–147 VMO. See Vastus medialis oblique intermediate view of, 185f
Upward rotation, 10 lateral/medial views of, 189f–190f,
Upward tilt, 10 189f–190f
W posterior views of, 187f–188f, 187f–188
Wad of three, 181 superficial view of, 187f
V Whiplash, 281, 283
Vastus intermedius, 372–375. See also Winging of the scapula, 153
X
Quadriceps femoris group Wrist extensor group, 210–213. See Extensor
actions, 374 carpi radialis brevis; Extensor carpi Xiphoid process, 129f, 265, 270
anterior views of, 373f radialis longus; Extensor carpi
attachments, 373 ulnaris
Z
derivation, 373 actions, 211
functions, 339–340 attachments, 211 Z-lines, 94, 94f
innervation, 374 derivation, 211 Zygomatic bone, 125f
palpation, 374, 374f functions, 182 Zygomaticus (head), 326
pronunciation, 372 innervation, 211 Zygomaticus major, 322–334
reverse mover actions, 339–340 palpation, 211–212 actions, 326
structures, relationship, 372 posterior view of, 210f anterior views of, 323f, 327f
treatment considerations, 375 pronunciation, 210 attachments, 326
Vastus lateralis, 372–375. See also structures, relationship, 210 derivation, 325
Quadriceps femoris group treatment considerations, 213 function, 300
actions, 374 Wrist flexor group, 210–213. See also Flexor innervation, 330
anterior views of, 372f carpi radialis; Flexor carpi ulnaris; palpation, 331, 331f
attachments, 373 Palmaris longus; Extensor carpi pronunciation, 322
derivation, 373 ulnaris structures, relationship, 322
functions, 339–340 actions, 199 treatment considerations, 334
innervation, 374 anterior view of, 198f Zygomaticus minor, 322–324
palpation, 374, 374f attachments, 199 actions, 326
pronunciation, 372 derivation, 199 anterior views of, 323f, 327f
reverse mover actions, 339–340 innervation, 199 attachments, 326
structures, relationship, 372 palpation, 200 derivation, 325
unipennate muscle, 96f pronunciation, 198 function, 300
treatment considerations, 375 stretching exercise for, 440f innervation, 330
Vastus medialis longus (VML), 375 structures, relationship, 198 palpation, 330, 331f
Vastus medialis oblique (VMO), 375 treatment considerations, 201 pronunciation, 322
Vastus medialis, 372–375. See also Wrist joint structures, relationship, 322
Quadriceps femoris group anterior view of, 123f treatment considerations, 334
actions, 374 extensor carpi radialis brevis, crossing, 182
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SKELETAL MUSCLES OF THE BODY–ALPHABETICALLY

KNOW THE BODY: MUSCLE, BONE, AND PALPATION ISBN 978-0-323-08684-4

Vice President: Linda Duncan

Printed in the United States of America

Last digit is the print number: 9 8 7 6 5 4 3 21

treatment considerations given. Review questions and COMPANION CD

Q Musculoskeletal Anatomy Flashcards, second edition: NOTE TO THE STUDENT

Chapter 1: Basic Kinesiology, 1 Chapter 5: Bony Palpation, 117

Overview of Function: Muscles of the Wrist Erector Spinae Group:

Muscles of the Scalp: Hamstring Group:

Trunk Upper extremity body parts

Lower extremity body parts

Lower extremity body parts

Palmar often used in place

Dorsal often used in place

Plantar used for the inferior

Dorsal used for the superior

Lateral (entire body) Medial (entire body)

FIGURE 1-3 Various terms of location relative to anatomic position.

PLANES is perpendicular to the other two planes. Any plane

AXES MOVEMENT TERMINOLOGY

middle finger can only abduct; it can perform radial

Pronation of the forearm results in the posterior

Dorsiﬂexion/Plantarﬂexion Note: Horizontal flexion is also known as horizontal

JOINT ACTION ATLAS

FIGURE 1-7 Nonaxial actions of elevation/depression and protraction/retraction of the scapula at

Clavicle at the Sternoclavicular Joint

Arm at the Glenohumeral Joint

Reverse Action of the Scapula and Trunk at the Glenohumeral Joint

Forearm at the Elbow and Radioulnar Joints

Hand at the Wrist Joint

Fingers Two through Five at the Metacarpophalangeal and Interphalangeal Joints

Thumb at the Carpometacarpal Joint

Neck at the Cervical Spinal Joints

Trunk at the Thoracolumbar Spinal Joints

Pelvis at the Lumbosacral Joint

Elevation of the right pelvis Elevation of the left pelvis

Right rotation of the pelvis Left rotation of the pelvis

Mandible at the Temporomandibular Joints (TMJs)

Pelvis at the Hip Joint

Posterior tilt Anterior tilt

Depression of the right pelvis Elevation of the right pelvis

Right rotation of the pelvis Left rotation of the pelvis

Leg at the Knee Joint

Foot at the Ankle Joint

Foot at the Subtalar (Tarsal) Joint

Foot at the Subtalar and Ankle Joints

Lateral rotation Medial rotation

Toes at the Metatarsophalangeal and Interphalangeal Joints

FIGURE 1-37 Motion of the toes at the

________________________________________________ 8. As a general rule, in what direction does a body

Clavicle Cervical vertebrae

Radius Rib cage

Sacrum Pelvic bone

Fat pad Fibrous capsule

Distal humerus Synovial

Triaxial Joints Nonaxial Joints

ATLAS OF BONY LANDMARKS AND MUSCLE ATTACHMENT SITES ON BONES

Lesser tubercle Subscapular fossa

Radial tuberosity Ulnar tuberosity

Trapezius Pectoralis minor

Lesser tubercle Serratus anterior

Pectoralis major Triceps