MUSCULAR SYSTEM (systema musculare)

General structure of muscle

Skeletal muscle is striated muscle, the contraction of which depends on the man's will, so this is
voluntary muscle. There are about 400 striated muscles in the human body.
Muscle (musculus) is a body organ built of bundles of striated muscle fibers joint with soft connective
tissue which contains blood vessels and nerves. The muscular system makes up about 40% of the human body
mass.
Structural unit of skeletal muscle tissue is the muscle fiber. Each muscle is composed of bundles of
muscle fibers covered by connective tissue sheath – endomysium (endomysium). Bundles of different size are
covered with internal perimysium (perimysium) and the whole muscle is covered on the outside with
epimysium (epimysium). Epimysium is continuous on to the external surface of the tendon, this its part is
called peritendineum (peritendineum, Fig. 1).
Muscle is attached to bone with the help of tendons, which have a close connection with endomysium
and muscle sarcolemma; a tendon is a dense fibrous connective tissue. Bundles of this connective tissue are
arranged in parallel and are joined by layers of soft tissue in which blood vessels run. Tendons are cylindrical
in shape, some muscles (particularly the abdominal muscles) have tendons in the form of thin wide sheets,
they are called aponeurosis (aponeurosis). There are muscles with the so-called tendinous inersections
(intersectio tendineа), which a muscle can have several of. Such intersections are characteristic of the rectus
abdominis muscle.
Muscles have a good blood supply which is furnished by blood vessels – arteries accompanied by two
veins. Intramuscular arteries are located in endomysium, they form arterial networks, which loops are
elongated lengthwise the muscle fibers. Muscles have motor and sensory neurons. Motor neurons end in
contractile tissue of muscle fiber in neuromuscular junctions, sensory neurons Innervate both muscular
elements and tendons.
Every muscle has a thicker middle part, belly (venter), and tendon (tendo), which anchor the
majority of muscle at both ends. Muscle starts with a head (caput), a point of fixation (punctum fixum), which
is attached to the bone with proximal tendon or muscle tissue and is located closer to the median axis of the
human body. The distal tendon is attached to another bone (Fig. 2), and the point of the attachment of a
muscle (insertio) is ldistal (a movable point, punctum mobile) from the median axis of the human body. When
a muscle contracts, one its end remains stationary. The fixation point and the movable point can swap roles
under certain conditions.
Muscles have different shapes (Fig. 3, 4) and are divided into long, short and wide. Long muscles are
mainly located in the limbs, wide ones in the back, the chest and in the abdomen. Short muscles are the deep
muscles of the back. Muscles can have a circular direction of fibres, for example, a circular eye muscle or
circular muscles of the mouth. These muscles perform the function of contraction.
Muscles are divided into simple and complex. Simple muscles have a head, a belly and one tendon.
Complex muscles include:
a) muscles which have two, three, four heads, for example: a two-headed muscle of the arm or the
thigh (m. biceps), a three-headed muscle of the arm or the leg (m. triceps), a four-headed muscle of the thigh
(m. quadriceps), etc.;
b) muscles which have several tendons, for example: superficial and deep muscles of the forearm – the
flexors of the fingers (m. superfіcialis et flexor digitorum profundus), long muscles of the leg – flexors and
extensors of the toe (m. flexor digitorum longus m et. extensor digitorum longus);
c) muscles in which the conjoint belly is separated by the intermediate tendon (tendo intermedius)
into two bellies, for example: the double-bellied muscle (m. digastricus), the omohyoid muscle (m.
omohyoideus);
g) muscles in which the belly is crossed by one or more tendinous intersections (intersectiones
sectiones), for example: the rectus abdominis muscle (m. rectus abdominis); the semimembranosus thigh
muscle (m. semimembranosus).
Regarding the direction of the muscle fibers muscles are divided into those in which the muscle fibers
are straight, parallel to each other, and those in which the fibers are arranged at an angle to the tendon.
Following the principle of attachment of muscle fibres to the tendon, there are muscles in which the oblique
muscle fibers converge at an acute angle and are attached to the tendon on both sides, such as the bipennate
muscle (m. bipennatus), and those in which muscle fibers run obliquely, at an acute angle, but are attached to
the tendon on one side, such as the unipennate muscle (m. unipennatus). There are muscles with different
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direction of the fibers such as the deltoid muscle (m. deltoideus). This is so-called the multipennate muscle (m.
multipennatus, Fig. 4).2
Individual muscles or their groups that during contraction perform oppositely directed action are called
antagonists, and muscles performing the same movement are called synergists.
The origin of the names of the muscles is various. Thus, the name of a muscle may reflect its shape –
trapezius, diamond, square muscle, circular muscle; some muscles have the name that describes their size:
large, small, short, wide, long muscles; the name of the muscles may reflect: direction of muscle fibers –
oblique, transverse muscles; structure of muscle – two-headed, three-headed, four-headed, double-bellied
muscles; the name of the muscle can contain where it begins and attaches, such as brachioradial or
sternocleidomatoid muscles; the name of a muscle may reflect its function – flexor, extensor, rotator, pronator,
supinator, levator, tensor, sphincter, adductor, abductor, and opponen muscles.
Depending on the number of joints a muscle 3 affects there are distinguished one joint, two joint and
multi joint muscles. There are muscles that do not affect any joints, for example, stylohyoid muscle and
thyrohyoid muscle.
Auxiliary apparatus of muscles
In performing their function muscles are helped by fascia, tendon sheaths, fibrous and bony-fibrous
canals, synovial bags, blocks and sesamoid bones.
Fascia (fascia) is the connective cover. Muscle fascia covers individual muscles, muscle groups;
individual muscles are separated from other muscle groups, forming fascial sheaths. Fascia splits into sheets
that separate one layer of muscles from the other. During the contraction of muscles covered with fascia
muscle friction is decreased. Fascia forms sheaths around the neurovascular bundles. A muscle tendon can be
attached to the fascia. Fasciae form capsules for the organs, for example, on the neck for the thyroid gland,
larynx, trachea, pharynx, esophagus, bags paniniwalang and parotid glands.
Fascial sheets and fascial partitions, in particular, those that adhere to the bone, form the fibrous
skeleton, which is also called the soft skeleton. The development of fascia depends on muscle development.
Fasciae can be involved in formation of the canal walls, so transverse fascia is involved in the formation of
posterior wall of the inguinal canal, fascia Lata - in the formation of the anterior and posterior walls of the
femoral canal.
Fasciae are called, depending on the names of the sections where the fascia is located. They can have
the name of the organ which they cover (e.g., the parotid fascia, the Buccopharyngeal fascia).
In case of inflammation of tissues the fascia prevents the spread of infection, but in some cases they are
its conductors.
In the area of the wrist and ankle joints fascia thicken, they mostly have circular fibres that adhere to
the bones of the forearm, ankle and foot. They are so-called rectinacula of the muscles (retinacula
musculorum). Special partitions, which adhere to periosteum, run from them to the bones (ulna and radius
bones, or tibia, fibula and foot bone respectively). Thus, under the rectinacula of the muscles there are formed
special fibrous sheaths (vaginae fibrosae), in which there run tendons of muscles covered with synovial
sheaths (vaginae synoviales) formed by the synovial membrane.
Synovial sheath has two layers: the visceral (lamina visceralis), which coalesces with a tendon, and
parietal (lamina parietalis), which coalesces with a fibrous sheath. At the ends of tendon sheaths the parietal
layer transforms into the visceral one. Thus, there forms a slitlike cavity of the tendon sheath, filled with a
small amount of synovial fluid, which lubricates the facing surfaces of both parietal and visceral layers of the
synovial sheath. This provides the reduction in friction of the tendon, which creates optimal conditions for the
functioning of the muscles. The parietal layer goes into the visceral layer of the synovial sheath all the length
of the sheath, then it is called the mesotendon (mesotendinеum), or only in some parts of the sheath, forming
the frenulum of the tendon (vincula tendinum). Mesotendon contains blood vessels and nerves, they are
placed between the two synovial layers of the mesotendon (Fig. 5).
Synovial bag (bursa) is a sac of connective tissue filled with viscous fluid similar to synovial.
Synovial bags located under tendons and under muscles, are attached to bones or other tendons and reduce the
friction during the contraction of muscles. If the bag is located near a joint, it can adhere to the articular cavity.
In such cases, it is called a synovial bursa (bursa synovialis). Synovial bursa is filled with synovial fluid.
Muscular trochlea (trochlea muscularis) is a bone protrusion which has a covered with cartilage
groove for the tendon of the muscle. The trochlea provides support for tendons, reduces the angle between the
tendon and the bone to which the tendon is attached and increases the lever force.
Sesamoid bones (ossa sesamoidea). They are located deep in the tendons near where they attach.
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Sesamoid bones are patella and pisiform bones. Sesamoid bones are located at the base of the proximal
phalanges of fingers (particularly a thumb) and toes. The function of sesamoid bones is the same as of
musclular trochlea.
Rules by P. F. Lesgaft, the founder of functional anatomy:
1) overall, muscle provide movements in those parts of the human body to which they are attached;
2) muscles provide movement in the joints through which they pass;
3) muscle provide the movement in the direction or to the side on which they are located: if muscles
are located on the anterior surface, they perform the forward movement, that is, they bend parts of the body;
if the muscle is located on the rear surface, then they unbend; those located on the medial surface – abduct;
on the side – adduct;
4) muscles provide the movement around those axes that they cross;
5) muscles mostly start from the bones and fascia with a wide area, and attach with their tapered ends;
P. F. Lesgaft called it a “proximal concentration of engines.” That is why limbs are tapered in shape (P. F.
Lesgaft. Fundamentals of theoretical anatomy. – S. Pb., 1905. – Part 1).
General concepts of biomechanics of muscles
The main characteristic of muscles is their ability to contract, which leads to a change in their length
under the influence of nerve impulses. During muscular contraction the points of the origin and the insertion to
the bones approach each other, the length of the muscle decreases. Bones, connected with joints function as
levers.
In biomechanics there are two types of levers: first class lever and second class lever. The main
characteristic of the first class lever is that the points of effort force are located on opposite sides of the
fulcrum, whilst the second class lever has the forces that are applied at one side of the fulcrum.
First class lever is a double-arm one (linkage equilibrium), its example can be the attachment of the
spine with the skull (Fig. 6, And). Here the balance is achieved by matching the moment of rotation of effort
force and the moment of rotation of the opposite gravity. The first moment of force is equal to the force acting
on the occipital bone, that is, on the length of the lever from the point of its fulcrum; the second moment of
force is equal to the gravity multiplied by the distance from the fulcrum to the extreme point of the face.
The second class lever is one-armed, however, depending on the point of application of forces of
muscles and gravity, it is divided into speed lever and strength lever.
The characteristic of the strength lever is that the shoulder of application of muscle strength is longer
than the shoulder of the counter action (Fig. 6, II). For example, the foot pivot point (axis of rotation) are the
heads of metatarsus, the point of application of muscle strength (triceps muscle of the calf) is he calcaneus,
and the point of counter action (body weight) is the ankle joint. When performing its function this lever has a
lower velocity of moving the point of counter action, because the shoulder of application of muscle strength is
longer than the shoulder on which body weight applies.
The characteristic of the speed lever is that the shoulder of application of muscle strength is much
shorter than the shoulder of the counter action (Fig. 6, II). As a result of overcoming the gravity, which is
located at a considerable distance from the pivot point, for example in the elbow joint, a much larger force of
the flexors, which are attached at a close distance from the elbow joint, is required. In this case, the velocity
and volume of movements of the longer lever dominate, and there occur losses in performing strength actions.
Thus, each muscle affects the joint in one direction only. Uniaxial joints, such as cylindrical, have only
two groups of antagonist muscles which affect them: one group – flexors, the second – extensors. Biaxial
joints are affected by muscles that are located around both of the axes of the joints. Multiaxial joints are
affected by the muscles that are located on all sides. For example, the shoulder joint is affected by flexors and
extensors (movement occurs around a frontal axis). Muscles abduct and adduct the upper limb (movements
occur around satalino axis) and rotators (movements occur around the longitudinal axis) – rotate the upper
limb medially (pronators) or outward (supinators).
To the group of synergist or antagonist muscles belong the muscles that provide the main and auxiliary
movements. During muscle contraction the human body is held in the appropriate position. Following this,
three types of muscles are distinguished: muscles that overcome resistance; muscle which are overcome by
resistance; and muscles that hold the weight.
In the first case, the muscles contract and change the position of the parts of the body; in the second
case, the strength of the muscles is overcome by the gravity. In the third case, the muscles hold the weight
without moving the body and its parts in space.

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 Studying strength and functional peculiarities of the muscles, there distinguish anatomical and
physiological cross-section areas. Anatomical cross-section area is the area of perpendicular cross-section of
the muscle in the middle part, it does not consider the strength of all the muscle fibers that make up a muscle.
(Fig. 6). The first indicator characterizes mainly the muscle mass, the second does its force. Absolute muscle
force is calculated by dividing the mass of the maximum weight ( in kilograms) that a muscle can raise , per 1
cm2 of the area of the physiological cross-section area. This figure for different muscles in a human body is
from 6,24 to 16.8 kg/cm2. For example, the absolute force of the biceps is 11.4 kg/cm 2. The tension one
muscle fiber develops during contraction ranges 0.1 – 0.2 g.
One of the indicators of the functions of an individual muscle is the amplitude, or magnitude, of the
reduction of muscle fibers. Fusiform and ribbon-like (strap) muscles have long fibers, so the physiological and
anatomical cross-sections coincide; the these muscles force is negligible. Physiological cross-section of
pennate muscles is much larger than anatomical one, so their force is larger than the force of other muscles.
Since the fibers of these muscles are short, their reduction amplitude is insignificant.
By changing the position of the bone levers, muscles affect the joints. Thus, each muscle affects the
joint in one direction only. Muscles which affect the joint while performing opposite functions are called
antagonists, and those that act in the same direction are called synergists.
Muscle action depends on the area of their origin and insertion and whether there is a tuberosity, crista,
process etc. in the points of muscle attachment to the bone. Muscles with a large area of the origin and
insertion are able to exert larger force and less fatigue (gluteus maximus). Muscles with a small area of
fixation (hand muscles) are better adjusted to performing rapid and varied movements.
The importance of muscle contractions lies in providing venous return of blood and lymph in the
limbs, heart and internal organs, providing the functions of the respiratory, digestive, metabolic functions and
reflex effect on organs and organ systems, etc.
The development of skeletal muscle
Most striated skeletal muscles in humans in embryogenesis develop from myotome in the spinal
(dorsal) part of the middle mesoderm germ layer which is located on either side of the notochord, and only
some of them (chewing, facial muscle) develop from mesenchyme of branchial arches.
Mesoderm has two divisions: dorsal, located on both sides of the neural tube and the notochord, and,
attached to them with a mesoderm Nephrotome, ventral (splanchnotomy). At the end of week 3 of
embryogenesis in the dorsal division of mesoderm along the head-to-tail axis of the embryo body there for
paired, cube-shaped spinal segments or somites. By the end of week 4 of embryonic development the embryo
has up to 40 somites: 3 to 5 occipital, 8 cervical, 12 thoracic, 5 lumbar, 5 sacral, 4 – 5 tail somites. Inside each
somite forms a cavity (myocoele) which divides the somite into intermediate and lateral plates. Cells of the
lateral plate of somites form dermatome from which skin is derived. The lower part of intermediate plate of
somites turns into sclerotome (from lat. scleros – hard). Sclerotomes give rise to the spine. Dorsal parts of
intermediate plates of somites that remain after the formation of sclerotome are called myotomes, they
primarily form skeletal muscles. According to their location myotomes are divided into prootic(3), occipital
(4), cervical (8) thoracic (12) lumbar (5), sacral (5) and coccygeal (4).
With the growth of myotomes and turning them into syncytial mass, their cavity disappears. From this
syncytial mass striated muscle fibers are formed, which have metamere position (Fig. 7). Expanding by
segmental type in the ventral direction, myotomes divide into ventral and dorsal parts. At this stage of
development each myotome gets linked to a certain section of the neural tube – neuromeres, from which to
myotome there run nerve fibers of the future spinal nerve. These fibers are accompanied by muscles, which
arise from one or the other myotome.
From the dorsal parts of myotomes there develop deep (intrinsic) muscles of the back, which are
innervated by the posterior branches of the spinal nerves. Ventral parts of myotomes give rise to the muscles
which are located on the front and sides of the torso (deep chest muscles, muscles of the anterior and lateral
walls of the abdominal cavity, some separate muscles of limbs). These muscles are innervated by anterior
branches of spinal nerves.
Respectively, in the process of development, during the proliferation of muscle cells, nerve fibers
develop and branch out. Therefore, the level of origin of the nerve to the muscle may indicate the level of the
its primordium. The diaphragm can be taken as an example, as it develops from the fourth and fifth cervical
myotomes, descends to the lower opening of the thoracic cavity and is innervated by the long diaphragm nerve
from the cervical nerve plexus.

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 All the muscles that develop from one myotome are innervated by one spinal nerve. In those cases,
when neighbouring myotomes adhere to each other,neither of them loses connection with the corresponding
nerve. Therefore, muscles that develop from several myotomes are innervated by multiple nerves (e.g., rectus
abdominis).
In the early stages of embryonic development myotomes on each side are separated from each other by
connective tissue partitions, retaining segmental location. After the birth, the rest of this segmentation is found
in the deep muscles of the back, intercostal muscles and rectus abdominis.
In the development process many muscles migrate. There are three groups of these muscles. Part of the
muscles that develop on the trunk and do not migrate are called autochthonous (from the Greek autos the
same, chton – earth, autochtonos – native, local) – deep muscles of the back, intercostal muscles, muscles of
the abdomen. The second group are the muscles that have moved from the trunk or head to limbs. They are
trunkfugal muscle (from the Latin truncus –trunk, fugere – to flee; to run), which develop from the ventral
parts of myotomes and Gill muscles; with their distal ends pass from the trunk and skull to the upper limbs and
attached to their bones. Trunkfugal muscles include: trapezoidal, sternocleid-mastoid, large and small
rhomboid, anterior dentate, scapular-hyoid, subclavian muscles and also the muscle that lifts the spatula. The
third group of muscles is trunk-pectoral (from the Latin truncus – trunk, petere – to guide, start, heading
towards the trunk), these are the large and small pectoral muscles and the broadest muscle of the back. They
develop from mesenchymal bud of the upper limb and by their proximal ends "move" to the trunk where thry
attach to its bones.
Limb muscles develop from the ventral trunk muscles, they are innervated by brachial, lumbar and
sacral-coccygeal plexus, formed by anterior branches of spinal nerves. The head muscles develop in different
ways. Muscles that provide movement of the eyeball develop from the myotomes of the head somites (prootic
myotomes). the muscles of the tongue. Chewing and mimic and some neck muscles develop from the ventral
non-segmented mesoderm at the location of visceral and gill arches. These muscles are called visceral.
Chewing muscles are formed from the muscular bookmark of the first visceral arch. The development of the
mimic muscles is done from the bookmark of the second visceral arch. On the basis of the muscles of gill
arches the trapezoidal and sternocleidomastoid muscles develop.
Quite often there occur abnormalities in the development of the skeletal muscles, especially in the
upper extremities. The most common of them are the complete absence of individual muscles, appearance of
new muscles; various changes in shape, location and size of the muscles (lack or insufficient development of
certain parts of the muscle and its tendons, the adherence with other muscles, changes of its origin and
insertion).
MUSCLES OF BACK (musculi dorsi)
The area of the back is bounded above by the superior nuchal lines, at the bottom - by the iliac crests,
at the back - by the anterior lateral edge of the trapezoid muscles and posterior axillary lines until their
intersection with the iliac crests.
Classification of muscles of back (musculi dorsi). They are divided into two groups: 1) superficial
(heterochthonous) muscles that are attached to the bones of the pectoral girdle, humerus, and ribs (in the
process of development they moved to the back from other areas and are located disposed on the surface); 2)
deep (autochthonous) muscles, which are the intrinsic muscles of the back. These muscles are fixed to bones
of the trunk and skull, have a segmented structure, their laying is on the back.
SUPERFICIAL BACK MUSCLES
1. Trapezius muscle (m. trapezius) located superficially.
Origin: external occipital protuberance, superior nuchal line, nuchal ligament, spines of all thoracic vertebrae.
The tendon bundles of muscles at the level of the cervical and upper thoracic vertebrae form the tendon plane.
Attachment: humeral end of the clavicle, acromion, spine of the scapula.
Function: the upper beams pull the scapula and clavicle upwards, the average closer the shoulder blade
towards the middle, the bottom pull the shoulder blade down. If the pectoral girdle is fixed, it bends the head
and neck to the same side, turning the face to the opposite side, while during bilateral contraction it throws her
head backwards.
2. Latissimus dorsi (m. latissimus dorsi) is located in the surface layer, partly covered by the trapezius
muscle.
Origin: posterior third of the outer lip of iliac crest of Ilium, spinous processes of six lower thoracic, all
lumbar vertebrae, median sacral crest, three or four lower ribs, inferior angle of the scapula.
Attachment: crest of the lesser tubercle of the humerus.
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Function: lowers the raised arm, pulls the lowered arm backwards and medially, rotates it medially, lowers
the scapula. If the upper limbs are fixed, it draws the trunk closer to them, raises the pelvis, and is also
involved in the act of inhalation.
3.Major and minor rhomboid muscles (mm. rhomboidei major et minor) are located under the
trapezius muscle, in the second layer.
Origin: spines of VI-VII cervical and I-IV thoracic vertebrae.
Attachment: medial border of the scapula.
Function: draw scapula towards the spine and upwards.
4. Levator scapulae (m. levator scapulae) is located in the second layer under the trapezius muscle.
Origin: transverse processes of I-IV cervical vertebrae.
Attachment: superior angle of the scapula, partially its medial border.
Function: elevates the scapula, bringing it closer to the spine.
5. Serratus posterior superior (m. serratus posterior superior) is located under the rhomboid
muscles, in the third layer.
Origin: spines of VI-VII cervical and I-II thoracic vertebrae.
Attachment: II-V ribs, a bit to the side from their angles.
Function: raises II-V ribs, provides inhalation.
6. Serratus posterior inferior (m. serratus posterior inferior) is located under latissimus dorci, in the
second layer.
Origin: spines of XI-XII thoracic and I-II lumbar vertebrae.
Attachment: IX-XII ribs.
Function: lowers IX-XII ribs, provides active exhalation.
DEEP MUSCLES OF BACK
To the deep muscles of back belong long and short muscles.
Long deep muscles of back
1. Splenius capitis and cervicis (mm. splenius cervicis et capitis) are located under the trapezius,
rhomboid and serratus posterior superior.
Origin: spines of III-VII cervical and I-VI thoracic vertebrae.
Attachment: transverse processes of I-III cervical vertebrae, mastoid process of the temporal bone, superior
nuchal line of the occipital bone.
Function: bends the neck and rotates the head in the same direction, in the case of bilateral contraction it
extends the neck and draws the head backward.
2. Erector spinae(m. erector spinae) is the strongest muscle of back, located all way long from sacrum
to the head.
Origin: dorsal surface of sacrum, spinous processes of lumbar vertebrae, posterior crest of the Ilium, thoracic
fascia. Above its origin the muscle is divided into three parts: iliocostalis, longissimus, and spinalis.
a) iliocastalis (m. іliocostalis) is located laterally; is divided into the iliocostalis lumborum (m.
iliocostalis lumborum) and iliocostalis cervicis (m. iliocostalis cervicis).
Attachment: I-XII ribs, transverse processes of IV-VI cervical vertebrae, costal processes of lumbar vertebrae.
b) longissimus (m. longissimus) is located midway between iliocostalis and spinalis. In length it is
divided into longissimus thoracis (m. longissimus thoracis), longissimus cervicis (m. longissimus cervicis),
and longissimus capitis (m. longissimus capitis).
Attachment: transverse processes of lumbar, thoracic, cervical vertebrae, II-XII ribs, mastoid process of the
temporal bone.
C) spinalis (m. spinalis) is located medially, along the spinous processes, is divided into spinalis
thoracis (m. spinalis thoracis), spinalis cervicis (m. spinalis cervicis) and spinalis capitis (m. spinalis capitis).
Attachment: spinous processes of thoracic and cervical vertebrae.
Function: erector spinae in case of bilateral contraction extends vertebral column and neck, lowers the ribs.
Plays a role in the statics of vertebral column. Counteracts bending the spine forward. In case of reduction on
one side only, tilts vertebral column and head to the same side.
3. Transversospinales (mm. transversospinales) are located along the entire vertebral column – from
sacrum to occipital bone, under erector spinale. Transversospinales consist ofseparate bundles running
obliquely from the transverse processes of the vertebrae, which are located below, to spinous processes of the
vertebrae that are located above. Is divided into three parts: semispinalis, multifidus, rotatores.
 semispinalis (m. semispinalis) is superficial bundles of fibers, which spread across 5-6 vertebrae.
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It is divided into semispinalis thoracis (m. semispinalis thoracis), semispinalis cervicis (m. semispinalis
cervicis), semispinalis capitis (m. semispinalis capitis); it attaches to the occipital bone between superior and
inferior nuchal lines.
Function: semispinalis extends thoracic and cervical regions of vertebral column; during unilateral
contraction rotates its cervical and thoracic divisions in opposite directions; during bilateral contraction, draws
the head backwards.
 multifidus (mm. multifidi) are the middle layer of bundles, which spread across 3-4 vertebrae; the
muscles are located from sacrum to the second cervical vertebra.
Function: rotate thevertebral column around its longitudinal axis, are involved in extension and bending the
spine to the side.
 rotatores (mm. rotatores) is the deepest layer of bundles of transversospinales, they spread across
one vertebra (or go to the nearby vertebra, which is located above). There are distinguished rotatores
lumborum, thoracis and cervicis.
Function: rotate the spine around its longitudinal axis, during bilateral contraction they unbend spine, tilt the
head backwards; during unilateral one, they rotate vertebral column; in case of tilting the head backwards,
they rotate face in the opposite direction.
Short deep muscles of back:
1. Interspinales (mm. interspinales) connect the spinous processes of adjacent vertebrae. There are
distinguished interspinales lumborum, thoracis and cervicis.
Function: extend cervical and lumbar divisions of vertebral column.
2. Intertransversarii (mm. intertransversarii) connect the transverse processes of adjacent vertebrae.
There distinguish medial lumbar intertransversarii, thoracic intertransversarii and medial posterior cervical
intertransversarii.
Function: extention of cervical and lumbar divisions of the spine to their side.
FASCIA OF BACK
Thoracolumbar fascia (fascia thoracolumbalis) covers erector spinae. The fascia has three layers –
posterior (lamina posterior), which is located behind erector spinae and is adherent to the aponeurosis of the
latissimus dorsi; middle (lamina media) and anterior (lamina profunda), which is located in front of erctor
spinae and adheres to the XII rib, iliac crest, transverse processes of lumbar vertebrae. The posterior layer
covers quadratus lumborum muscle, so it is also called quadratus lumborum fascia (fascia musculі quadrati
lumborum).
Nuchal fascia (fascia nuchae) is a thickened plate located at the back of the neck between the
superficial and deep layers of muscles; medially it is adherent to nuchal ligament, and at the sides – with
superficial layer of cervical fascia.
THE LIST OF PRACTICAL SKILLS
To show on a specimen: trapezius muscle, latissimus dorsi, rhomboid major, levator scapulae, serratus
posterior inferior, serratus posterior superior, parts of erector spinae, transversospinales, interspinales,
intertransversarii, rhomboid minor.
MUSCLES OF THORAX (musculi thoracis)
Muscles of thorax are divided into two groups:
1) superficial (heterochthonous)muscles of the upper extremities; they start on the bones of the trunk
and are attached to the bones of pectoral girdle and humerus;
2) deep (autochthonous) - proper muscles of thorax, which are laid and develop in the thorax.
Superficial muscles of thorax
1. Pectoralis major (m. the pectoralis major). Has three parts: clavicular head (pars сlavicularis),
sternocostal head (pars sternocostalis), abdominal part(pars abdominalis).
Origin: medial part of clavicle, anterior surface of sternum and cartilages of II-VII ribs, the front wall of the
sheath of rectus abdominis muscle.
Attachment: crest of greater tubercle of the humerus.
Function: adducts the upper limb, rotates it inward, lowers the raised upper limb, draws the shoulder forward.
If the upper limb is fixed raises II-VII ribs, taking part in the act of inhalation.
2. Pectoralis minor (m. peсtoralis minor) is located under pectoralis major.
Origin: II-V ribs.
Attachment: coracoid process of the scapula.
Function: draws the scapula forward and down. If the scapula is fixed, it raises the II-V ribs, taking part in the
7
act of inhalation.
3. Serratus anterior (m. serratus anterior) is located on the side wall of thorax.
Origin: separate ribs from the first to VIII-IX ribs.
Attachment: medial border of the scapula, its superior angle.
Function: draws the scapula forward and presses it to the trunk. Rotates the scapula around sagital axis so that
its superior angle moves forward and to the side, which results in the upper limb raising above horizontal
level. If the scapula is fixed, it raises the II-IX ribs, taking part in the act of inhalation (fig. 7).
4. Subclavius (m. subclavius).
Origin: cartilage of the first rib.
Attachment:inferior surface of the medial end of clavicle.
Function: strengthens the sternoclavicular joint, draws clavicle down and forward.
Deep muscles of thorax
Deep muscles of thorax have points of fixation to the ribs and so take part in the act of breathing (both
inhalation and exhalation).
1. External intercostal muscles (mm. intercostales externi) take up intercostal spaces from vertebral
column to cartilages of the ribs. Further, between the cartilages of the ribs they are replaced by external
intercostal membrane (membrana intercostalis externa). Muscles have an oblique direction of the fibers, from
top to bottom and back to front (Fig. 8).
Origin: the lower border of the rib that is located above.
Attachment: the upper border of the rib below.
Function: raise ribs, taking part in the act of inhalation.
2. Internal intercostal muscles (mm. intercostales interni), take up intercostal spaces from the
sternum to the angles of the ribs. From the angle of the ribs to the vertebral column they are replaced by
internal intercostal membrane (membrana intercostalis interna). Muscles have an oblique direction of the
fibres from the bottom up, from back to front.
Origin: the upper border of the rib that is located below.
Origin: the lower border of the rib that is located above.
Function: lowers ribs, participating in the act of exhalation
3. Subcostales (mm. subcostales) lie from the angles of ribs to the vertebral column. They have the
same fiber direction as internal intercostal muscles.
Origin: the upper border of the rib that is located below.
Attachment: the lower edge of the rib that is located above (spread over one or two ribs).
Function: lowers rib, participating in the act of exhalation.
4. Levatores costarum (mm. levatores costarum).
Origin: transverse processes of cervical VII, I-XI thoracic vertebrae.
Attachment: angles of the ribs below.
Function: raise ribs, participating in the act of inhalation.
5. Transversus thoracis (m. transversus thoracis).
Origin: posterior surface of the sternum.
Attachment: cartilages of II-VII ribs.
Function: lowers II-VII ribs, participating in the act of exhalation
FASCIAE OF THORAX
Superficial fascia (fascia superficialis) begins from the clavicle, goes down, dividing into superficial
and deep sheets that cover mammary gland in front and and from behind, thus forming suspensory ligaments
of breast (ligg. suspensoria mammaria).
Thoracic fascia (fascia thoracica) covers the ribs and intercostal muscles. It's proper fascia of the
thorax. It is adherent to the clavicle, is part of suspensory ligaments of breast in women and has superficial and
deep sheets. Within the clavicular-sternal triangle the deep thoracic fascia is thickened, it is isolated under the
name of clavipectoral fascia (fascia clavipectoralis). Its superficial sheet covers the outside of the pectoralis
major. The deep sheet forms separate sheaths for subclavius and pectoralis minor. Superficial and deep sheets
adhere in the deltoideopectoral sulcus, continuing in the deltoid fascia, then runs along the inferior border of
pectoralis major, continuing in the axillary fascia and fascia of serratus anterior . Between the deep sheet of
superficial fascia and superficial sheet of thoracic fascia, behind mammary gland, there forms retromammary
space filled with loose connective tissue, making mammary gland movable. When there is a malignant tumor
in the gland, its agility is lost due to sprouting of cancer cells in this space, then the gland is "soldered" to
8
pectoralis major. In such cases, if the upper limb is raised, the gland follows the hand up.
Endothoracic fascia (fascia endothoracica) is located under parietal pleura, it lines thoracic walls on
the inside, coveringinternal intercostal muscles, subcostales, transversus thoracis, ribs, the superior surface of
the diaphragm.
DIAPHRAGM
Diaphragm (diaphragma) separates thoracic cavity from the abdominal. Is a complex of soft
formations: 1) diaphragmatic pleura; 2) internal thoracic fascia, 3) diaphragm muscle; 4) intra-abdominal
fascia; 5) parietal peritoneum.
It consists central tendon (centrum tendineum) and muscular part. Central tendon occupies the central
part of diaphragm, whereas its muscular part is located in the periphery (Fig. 9).
Depending on the origin, muscular part of the diaphragm has three parts:
a) lumbar part (pars lumbalis diaphragmatis), which consists of right crus and left crus (crus dextrum
et sinistrum crus).
Origin: body of I-IV of the lumbar vertebrae, medial(lig. arcuatum mediale) and lateral (lig. arcuatum
laterale) arcuate ligaments. Medial arcuate ligament origins from the body of I lumbar vertebra and attaches to
the transverse process of II lumbar vertebra. Lateral arcuate ligament stretched from the transverse process of
the II lumbar vertebra to twelfth rib;
b) costal partof diaphragm (pars costalis diaphragmatis).
Origins from anterior surface of VII-XII ribs.
C) sternal part of diaphragm (pars sternalis diaphragmatis).
Origins from anterior surface of xiphoid process of sternum.
Attachment: muscle fibers of all three parts converge in central tendon of diaphragm.
In the central tendon there is caval opening (foramen venae cavae). The wall of the vein converges
with fibers in the central tendon. During diaphragm contraction, the fibers of the central tendon stretch the
walls of inferior vena cava into opposite directions, which helps blood flow. Between the right and left crus of
the lumbar part of diaphragm there is aortic hiatus (hiatus aorticus), through which pass the aorta and thoracic
duct. Aortic hiatus is restricted by median arcuate ligament (lig. arcuatum medianum), which prevents the
compression of aorta and thoracic duct during contraction of the diaphragm. To the left of the aortic hiatus
there is oesophageal hiatus (hiatus oesophageus), through which pass the esophagus and the right and left
vagus nerve. In each crus of the lumbar part of diaphragm, in the gaps between muscle bundles there pass
larger and lesser splanchnic nerve, on the right - azygos vein, on the left – hemiazygos vein, right and left
sympathetic trunks.
Weak parts of the diaphragm, in which there is no muscle tissue, are the following:
a) Sternocostal triangle (trigonum sternocostale), located to the right and left between the sternum and
the costal parts of the diaphragm;
b) lumbocostal triangle (trigonum lumbocostale), located to the right and left between the lumbar and
costal parts of the diaphragm.
In the area of the triangles there is located diaphragmatic pleura, endothoracic fascia, endoabdominal
fascia, and peritoneum. Here, diaphragmatic hernias, including congenital ones, can occur.
The location of the domes of diaphragm
 right dome – IV intercostal space to the right at the right midclavicular line (linea
medіoclaviсularis dextra);
 left dome – V intercostal space along the left midclavicular line (linea medioclaviсularis
sinistra). In children the diaphragm is higher, in the elderly - lower.
Function of the diaphragm: it forms the walls of the thoracic and abdominal cavities, is the main
respiratory muscle. During contraction the diaphragm flattens, lowers by 1-3 cm, where mainly its sides shift
downwards. Central tendon shifts negligibly. As a result of lowering the diaphragm the volume of the thoracic
and pleural cavities increases. Thus, the pressure (negative) in the pleural cavity falls, causing the expansion of
the lungs - the act og inhalation is performed.. During relaxation, the diaphragm gets a convex shape
(exhalation). Diaphragm predetermines the "abdominal" type of breathing in men and children; in women, the
expansion of the thorax occurs mainly due to the reduction of all the muscles that raise the ribs "thoracic"
breathing. The norm in the number of contractions of the diaphragm in an adult is 16-20 per 1 min.
Contracting together with the muscles of the abdominal wall, the diaphragm contributes to the emptying of
hollow organs – stomach, intestines, gallbladder, uterus during childbirth, etc., improves hemodynamics of
venous blood in the system of portal vein and inferior vena cava.
9
 THE LIST OF PRACTICAL SKILLS
Show on specimen:
Pectoralis major and minor, subclavius, serratus anterior muscle, internal and external intercostal
muscles, diaphragm - central tendon, hiatuses and muscle parts, "weak" places.
MUSCLES OF ABDOMEN (mm. abdominis)
Abdominal muscles form the abdominal walls. They are located on the anterior, lateral and posterior
walls of the abdomen (Fig. 10).
Muscles that form the anterior wall of the abdomen
1. Rectus abdominis (m. rectus abdominis) has three or four tendinous intersections (intersectiones
tendinae).
Origin: xiphoid process of the sternum and the anterior surface of the cartilages of V-VII ribs.
Attachment: the superior branch of the pubic bone, pubic symphysis, pubic tubercle.
Function: flexes vertebral column, tilts the trunk forward, pulls the V-VII ribs down. If the trunk is in a fixed
position, it raises the pelvis.
2. Pyramidalis(m. pyramidalis).
Origin: superior border of the pubic symphysis.
Attachment: linea alba.
Function: draws linea alba.
Muscles that form the lateral wall of the abdomen
These are three broad abdominal muscles. The first layer contains external oblique muscle, the second
layer (under the previous) – internal oblique muscle and the third layer contains transverse abdominal. It is
important to note, that the tendon of each of the three muscles has a sheet-like shape, that is it is a tendonous
sheet - aponeurosis.
1. External oblique muscle (m. obliquus externus abdominis) has an oblique direction of fibers: from
up down and back to front.
Origin: in digitations from eight lower ribs.
Attachment: external lip of iliac crest, anterior superior iliac spine, pubic bone; the muscle goes into a broad
aponeurosis, located in front of the rectus abdominis. On the median line of the abdominal aponeurosis is
connected with the same aponeurosis of the opposite side, contributing to the formation of the linea alba. The
lower border of the aponeurosis of the external oblique muscle bends backwards and upwards and forms
inguinal ligament (lig. inguinale). It origins on the anterior superior iliac spine and attaches to the pubic
tubercle.
Function: During bilateral reduction tilts the trunk forward, drawing the thorax to the pelvis (antagonist of
the longitudinal muscles of the back). During unilateral reduction rotates the thorax in the opposite direction.
2. Internal oblique muscle (m. obliquus externus abdominis) has an oblique direction of fibers: from
down up and back to front. It is located under the previous muscle.
Origin: thoracic fascia, iliac crest, lateral two thirds of inguinal ligament.
Attachment: X-XII ribs, it also transforms into aponeurosis, which is divided into two layers – anterior and
pasterior, they cover the front and back of the rectus abdominis muscle and on the medial line of the abdomen
intertwine with each other and with the same layers of aponeurosis of the internal oblique muscle on the
opposite side. The aponeurosis is involved in the formation of the walls of the rectus sheath and linea alba.
The lower bundles of muscle fibers are a part of the spermatic cord, formed by the cremaster (m. cremaster).
Function: during unilateral reduction tilts the trunk to its side, rotates the body to its side. During bilateral
reduction bends vertebral column forward (flexor of the spine), it draws the thorax to the pelvis. If the thorax
is fixed, it raises the pelvis. Lowers X-XII ribs, that is it is involved in the act of exhalation.
3. Transverse abdominal (m. the transversus abdominis), lies beneath the previous muscle.
Origin: internal surface of six lower ribs, posterior layer of thoracolumbar fascia, internal lip of iliac crest,
lateral third of inguinal ligament.
Attachment: the place of transition of muscle fibers into aponeurosis, has the appearance of a semilunar line
(linea semilunaris). The aponeurosis is involved in the formation of the posterior wall of the rectus sheath
(passing with the posterior layer of the aponeurosis of the internal oblique muscle behind the rectus
abdominis) – above the umbical region, and in the formation of the anterior wall of this sheath (passing,
together with the aponeurosis of the external oblique and the internal oblique muscles) below the umbical
region. In the area of the medial line of the abdomen the fibers of the aponeurosis intertwine with the same
fibers of the aponeurosis of the transverse muscle of the opposite side, contributing to the formation of linea
10
alba.
Function: during unilateral contraction tilts the body towards the contracted muscle. As with the
abovementioned broad abdominal muscles, the transverse abdominal during bilateral contraction flexes the
vertebral column, tilts the trunk forward; draws the six lower ribs down, taking part in the act of exhalation.
All the broad abdominal muscles during bilateral contraction flex the vertebral column and draw
muscles of the trunk forward. They lower the ribs and take part in the act of exhalation. Broad muscles of the
abdomen are the abdominal prelum. They maintain intra-abdominal pressure; contribute to emptying out of
internal organs: acts of defecation, urination, childbirth, coughing, vomiting. Due to the tonus of the muscles
of the abdomen the internal organs of the abdominal cavity are held in a natural position.
Inguinal ligament (lig. inguinale) is the inferior border of the aponeurosis of the external oblique
muscle, this region coalesces with the superior border of the broad fascia of the thigh (fascia lata), bends
backwards and upwards in the shape of a groove. Inguinal ligament origins from the anterior superior iliac
spine and attaches to the pubic tubercle of the pubic bone. In medial division the inguinal ligament is divided
into two legs: medial crus (crus mediale), which is attached to the anterior surface of the pubic symphysis, and
lateral crus (crus laterale), which is attached to the pubic tubercle. Between the crura there is a gap of
triangular shape, the anterior angle of which is formed by intercrural fibers (fibrae intercrurales). All these
structures form the superficial inguinal ring. From the medial division of the inguinal ligament there separate
the fibers, which go up and medially and woven into the linea alba, forming the reflected ligament (lig.
reflexum). The other part of the fibers, origining from the crus of the inguinal ligament, goes down and
attaches to the pubic crest of the pubic bone, and is then called lacunar ligament (lig. lacunare).
Muscles that form the posterior wall of the abdomen
Quadratus lumborum (m. quadratus lumborum) forms the posterior wall of the abdomen between the
XII rib and the iliac crest.
Origin: posterior division of the internal lip of the iliac crest, iliolumbar ligament, and transverse processes of
three or four inferior lumbar vertebrae.
Attachment: twelfth rib, transverse processes of I to IV lumbar vertebrae, the body of XII thoracic vertebra.
Function: lowers the XII rib, taking part in the act of exhalation; during unilateral contraction bends the spine
to the same side; during bilateral one it holds the vertabral coumn in a vertical position.
ABDOMINAL FASCIA. TOPOGRAPHY OF THE ABDOMEN
Abdominal fascia (fascia abdominis). They are divided into visceral, extraperitonal and parietal
abdominal fascia.
1. visceral abdomenal fascis (fascia abdominis visceralis) covers some of the abdominal organs and
forms for them subserous layer (see the topic "Peritoneum and its derivatives").
2. Parietal abdominal fascia (fascia abdominis parietalis) is located on the abdominal walls both
inside and outside depending on what it covers, there are distinguished such its parts: iliopsoas fascia,
transversalis fascia and investing abdominal fascia.
3. Iliopsoas fascia (fascia ilipsoas) covers the iliopsoas muscle on the posterior wall of the abdominal
cavity. Then, the fascia passes to the lateral wall of the abdominal cavity and is called the transversalis fascia
(fascia transversalis). In its inferior part this fascia thickens in the form of interfoveolar ligament (lig.
interfoveolare), which lateral part is one of the borders of the deep inguinal ring. Continuing down into the
pelvic cavity, parietal abdominal fascia is called parietal pelvic fascia. The part that lies on the diaphragm, is
called diaphragmatic fascia (fascia diaphragmatica).
4. Investing abdominal fascia (fascia investiens abdominis) is part of parietal abdominal fascia, and is
located more superficially than the first two fasciae. It forms several branches and covers abdominal muscles
from all sides (except for the internal surface of transversus abdominis).
On the anterior abdominal wall there are three regions:
1. epigastric region – epigastrium;
2. abdominal region – mesogastrium;
3. hypogastric region – hypogastrium.
The borders between these areas are:
a) the line connecting the anterior superior iliac spine;
b) the line connecting the anterior ends of the X ribs.
Along each lateral border of the rectus abdominis muscle there is drawn a pararectal line (left and
right), with which each of the three regions is in its turn divided into three other regions.
1. In the epigastric region there are distinguished: a) right and b) left hypochondriac regions – regio
11
hypochondriaca dextra et sinistrac) epigastric area proper – regio epigástrica propria.
2. In the abdominal region: a) right and b) left lateral regions – regio abdominalis lateralis dextra et
sinistra, c) umbilical region – regio umbilicalis.
3. In the hypogastric region there are distinguished: a) right and b) left inguinal regions – regio
inguinalis dextra et sinistra, c) pubic region – regio pubica .
Rectus abdominis sheath (vagina musculi recti abdominis) is a dense aponeurotic sheath. It is formed
by the aponeurosis of the three broad abdominal muscles (external oblique, internal oblique and transverse). In
the sheath of the rectus abdominis there distinguish anterior and posterior laminae.
The anterior lamina of the sheath (lamina anterior) is formed:
a) above the umbical region: the aponeurosis of the external oblique muscle and the anterior lamina of
the aponeurosis of the internal oblique muscle;
b) below the umbical regon: three aponeurosis: of the external oblique, internal oblique and the
transverse abdominal muscles (Fig. 11).
The posterior lamina of the sheath (lamina posterior) is formed:
a) above the umbical region: the prosperior plate of the aponeurosis of the internal oblique muscle and
the aponeurosis of the transverse abdominal muscles;
b) below the umbical region: transversalis fascia.
On the posterior plate of the sheath there is an arcuate line (linea arcuata, Douglasi), which is the
border between aponeurotic (above the line) and fascial (below the line) parts of the posterior plate of the
sheath. The arcuate line is curved upwards. Semilunar line (linea semilunares) is the place of transition of the
transversus abdominis into its aponeurosis. Semilunar line is curved outwards.
Linea alba (linea alba), is formed by interlacing fibres of the aponeurosis of three broad abdominal
muscles – the external oblique, internal oblique and transverse abdominal muscle, at both their own and the
opposite sides. Linea alba is stretched from the xiphoid process of the sternum to the pubic symphysis between
the recti muscles of the abdomen. Above the umbilicus it is wider, reaches 2-2,5 cm in width, and below the
umbilicus it narrows and thickens. Its thickening near the symphysis is called the posterior attachment of
linea alba (adminiculum lineae albae). The umbilical ring (anulus umbiliсalis) is located in the linea alba. It is
bordered by bundles of the aponeurosis of external and internal oblique muscles, as well as deep concentric
fibres of the aponeurosis of the transverse abdominal muscle. In the embryonic period of development through
the umbilical ring go two umbilical arteries, the umbilical vein, urinary duct. After the umbilical cord is
knotted and then detaches, the whole ring fills with connective tissue thickenings. In the area of linea alba and
umbilical ring can form herniae of linea alba, umbilical herniae. The linea alba is poor in blood vessels, so
surgeons incise the anterior abdominal wall if a wide access to the abdominal cavity is necessary.
Inguinal canal (canalis inguinalis) is a slit-like space in the anterior abdominal wall, which is located
in the inguinal region above the inguinal ligament. It is 4-5 cm long. The canal has an oblique direction from
top to bottom, back to front, from the side to the middle. In the inguinal canal there are further distinguished
the walls and two rings (holes).
The canal has four walls:
– anterior wall – aponeurosis of the external oblique muscle and intercrural fibers;
– posterior wall - transverse fascia;
– superior wall – free (lower) borders of the internal oblique and transverse abdominal muscles (both
muscular and aponeurotic parts);
– interior wall - the groove of the inguinal ligament.
Superficial inguinal ring (anulus inguinalis superficialis) has the following boundaries:
 medially– medial crus of the inguinal ligament;
 externally – lateral crus of the inguinal ligament;
 anteriory – intercrural fibers formed by superficial layer of the abdominal fascia;
 posteriory – reflected ligament.
Deep inguinal ring (anulus inguinalis profundus) is weak, conus-shaped recessed place in the loose
transversalis fascia, located 1 cm above the midpoint of the inguinal ligament, outside the lateral umbilical
fold and coincides with the location of the lateral inguinal fossa.
It is bounded medially and below by interfoveolar ligament, this ligament is formed by the thickened
fibres of the aponeurosis of the internal oblique and transverse muscles, transverse fascia. The posterior wall
of the inguinal canal is strengthened with theinguinal falx (falx inguinalis), formed by fibers of the
aponeurosis of the internal oblique and transverse muscles. Medially from the deep inguinal ring, in the lateral
12
umbilical fold there is the epigastric artery and two veins, located below. This is taken into account during
surgical interventions (Fig. 12).
Medial inguinal fossa coincides with the superficial inguinal ring. Lateral inguinal fossa coincides with
the deep inguinal ring.
When the viscera protrude within the lateral inguinal fossa, they pass through the deep inguinal ring,
through inguinal canal and leave it through the superficial inguinal ring. Such a pathological protrusion of the
viscera is called oblique inguinal hernia. When the viscera protrude within the medial inguinal fossa, they go
through the superficial inguinal ring (they do not go through the inguinal canal), forming the direct inguinal
hernia.
On the back of the abdominal wall, there are anatomical structures that also have clinical significance.
Hernia can also form there.
1. Petit lumbar triangle trigonum lumbale. It is limited by: anteriorly by the posterior border of the
external oblique muscle, posteriorly by the anterior border of the latissimus dorsi, inferiorly by the iliac crest.
The bottom of the triangle is the internal oblique muscle.
2.Tetragonum lumbale (tetragonum lumbale). It is bounded: superiorly by the XII rib and the inferior
border of the serratus posterior inferior m. serratus posterior inferior, medially by the erector spinale, m.
erector spinae, laterally by the posterior border of the external oblique m. obliguus externus abdominis,
inferiorly by the superior-medial border of the abdominal oblique muscle, m. obliquus internus abdominis,
internally by thoracolumbar fascia, externally by the latissimus dorsi, m. latissimus dorsi.
THE LIST OF PRACTICAL SKILLS
Show on specimen:
The rectus abdominis and its tendinous intercestions, the rectus sheath, the external oblique abdominal
muscle, the inguinal ligament, the internal oblique, the transverse abdominal, the linea alba, the umbilical
ring, the inguinal canal and its walls, the superficial inguinal ring, medial and lateral crura of the inguinal
ligament, the quardatus lumborum.

MUSCLES OF NECK (mm. coli)

They have a complex origin, are located in several layers. They are divided into superficial muscles,
muscles of the hyoid bone, and deep muscles of neck.
Superficial muscles of the neck
1. Platysma (platysma).
Origin: pectoral fascia at the level of the II rib.
Attachment: the border of the body of the mandible, the parotid fascia, the masseteric fascia, anguli oris
muscles.
Function:draws the skin of the neck, facilitates blood flow in the subcutaneous veins of neck, pulls the
corners of mouth down and back.
2. Sternocleidomastoid muscle (m. sternocleido-mastoideus).
Origin: with two heads from the manubrian of the sternum and the sternal end of the clavicle.
Attachment: mastoid process of the temporal bone, superior nuchal line.
Function: flexes the head and the neck to the side of the contracted muscle, rotating the face in the opposite
direction. During a bilateral reduction draws the head backwards.
Muscles of the hyoid bone (middle group)
Muscles of the hyoid bone can be divided into two subgroups: suprahyoid and infrahyoid muscles.
Suprahyoid muscles (musculi suprahyoidei)
1. Digastric (m. digastricus) has the anterior belly (venter anterior) and the posterior belly (venter
posterior) which are connected by the intermediate tendon.
Origin: anterior belly – digastric fossa of mandible; posterior belly: mastoid notch of the temporal bone.
Attachment:with the fascial loop the intermediate tendon is fixed to the body and the greater horn of the hyoid
bone.
Function: raises hyoid bone, and when it is fixed, draws the lower jaw down.
2. Mylohyoid muscle (m. mylohyoideus). Being a broad thin plate, it forms the floor of the oral
cavity of the mouth, that is, it is the diaphragm of the mouth.
Origin: mylohyoid line of the mandible.
Attachment: body of the hyoid bone. The tendon fibers of the two muscles in the midline form the mylohyoid
raphe (raphe mylohyoidea).
13
Function: raises the hyoid bone, draws it forwards, and when it is fixed, draws the lower jaw down.
3. Geniohyoid muscle (m. geniohyoideus). Is located on each side of the median line, on the superior
surface of the mylohyoid muscle.
Origin: mental spine of the mandible.
Attachment: body of the hyoid bone.
Function: raises the hyoid bone and draws it forward, when it is fixed, draws the lower jaw down.
4. Stylohyoid muscle (m. stylohyoideus). It is perforated by the tendon of the digastric muscle.
Origin: styloid process of the temporal bone.
Attachment: body of the hyoid bone.
Function: pulls the hyoid bone in a superior and posterior direction.
Infrahyoid muscles (musculi infrahyoidei)
1.Sternohyoid muscle (m. sternohyoideus).
Origin: posterior surface of the manubrian of the sternum, sternoclavicular joint capsule, the sternal end of the
clavicle.
Attachment: body of the hyoid bone.
Function: lowers the hyoid bone.
2. Sternothyroid muscle (m. sternothyroideus) is located under the sternohyoid muscle.
Origin: posterior surface of the manubrian of the sternum, cartilage of the first rib.
Attachment: the oblique line of the thyroid cartilage.
Function: lowers the thyroid cartilage.
3. Thyrohyoid muscle (m. thyrohyoideus).
Origin: oblique line of the thyroid cartilage.
Attachment: body and the greater horn of the hyoid bone.
Function: draws the thyroid cartilage and hyoid bone closer together.
4. Omohyoid muscle (m. omohyoideus). Has superior and inferior bellies (venter superior et venter
inferior), which are connected by a tendon.
Origin: the inferior belly origins at the superior transverse scapular ligament.
Attachment: the superior belly inserts into the body of the hyoid bone.
Function: pulls the hyoid bone in the inferior and posterior direction. Stretches the fascia, which covers the
internal jugular vein, and therefore extends this vein, thus facilitates the blood flow in it.
Deep muscles of the neck
Deep muscles of the neck are divided into two subgroups: medial (prevertebral) and scalene muscles
of the neck.
Scalene muscles of the neck
1. Anterior scalene muscle (m. sсalenus anterior).
Origin: anterior tubercles of the transverse processes of the III-VI cervical vertebrae.
Attachment: the tubercle of anterior scalene muscle on the first rib.
Function: bends the cervical part of the spine to the side of the contracted muscle. When contracts bilaterally,
tilts the neck forward. With a fixed spine it lifts the first rib, participating in the act of inhalation.
2. Middle scalene muscle (m. scalenus medius).
Origin: anterior tubercles of the transverse processes of all cervical vertebrae.
Attachment: the first rib, behind the groove of the subclavian artery.
Function: bends the cervical part of the spine to the side of the contracted muscle. During bilateral conraction,
it tilts the neck forward, and if the spine is fixed, it lifts the first rib, participating in the act of inhalation.
3. Posterior scalene muscle (m. scalenus posterior).
Origin: posterior tubercles of the transverse processes of V-VII cervical vertebrae.
Attachment: the second rib.
Function: bends the cervical part of the spine to the side of the contracted muscle. During a bilateral
contraction, tilts the neck forward. If the spine is fixed, elevates the second rib, is involved in the act of
inhalation.
Prevertebral muscles of the neck
1. Longus colli muscle (m. longus coli).
Origin: the bodies of upper three thoracic and lower three cervical vertebrae and the transverse processes of
the upper three cervical vertebrae.
Attachment: transverse processes and bodies of the cervical vertebrae, anterior tubercle of atlas.
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Function: tilts the neck to the side of the contracted muscle and when contracted bilaterally, tilts the neck
forward.
2. Longus capitis (m. longus capitis).
Origin: anterior tubercles of the transverse processes of third to sixth cervical vertebrae.
Attachment: the main part of the occipital bone.
Function: flexes the neck and bends the head forward.
3. Rectus capitis nterior (m. rectus capitis anterior).
Origin: lateral mass of atlas.
Attachment: the main part of the occipital bone.
Function: tilts the neck to the side of the contracted muscle and when contracted bilaterally, tilts the neck
forward.
4. Rectus capitis lateralis (m. reсtus сapіtis lateralis).
Origin: transverse process of atlas.
Attachment: the lateral part of the occipital bone.
Function: tilts the neck to the side of the contracted muscle and when contracted bilaterally, tilts the neck
forward.
Suboccipital muscles (mm. suboccipitales)
They are located between the occipital bone and the first two cervical vertebrae (Fig. 14).
1. Rectus capitis posterior major (m. rectus сapitis posterior major).
Origin: the spinous process of the second cervical vertebra.
Attachment: lateral division of the inferior nuchal line.
Function: with a bilateral contraction it throws her head backwards, with a unilateral one it turns it to its side.
2. Rectus capitis posterior minor (m. rectus capitis posterior minor) is located under the rectus
capitis posterior major.
Origin: posterior tubercle of atlas.
Attachment: medial part of the inferior nuchal line, occipital bone.
Function: throws the head back.
3. Obliquus capitis superior (m. obliquus capitis superior).
Origin: transverse process of atlas.
Attachment: inferior nuchal line.
Function: throws the head back.
4. Obliquus capitis inferior (m. obliquus capitis inferior).
Origin: the spinous process of the second cervical vertebra.
Attachment: transverse process of atlas.
Function: rotates the head in the same direction.
CERVICAL FASCIA THE TOPOGRAPHY OF THE NECK
There are four regions of the neck: posterior cervical region, anterior cervical region,
sternocleidomastoid region and lateral cervical region.
Anterior cervical region
In the regio cervicalis anterior there is the medial triangle of the neck (trigonum cervicis mediale). It
is bounded: from the top by the border of the mandibular body, medially by he anterior median line, from the
back by the anterior border of sternocleidomastoid.
In the medial triangle of the neck there are:
1. Submandibular triangle (trigonum submandibulare) is limited from the top: the border of the
mandibular body, front and bottom – anterior belly of the digastric, behind and bottom - the posterior belly of
the digastric.
2. The Pirogov triangle (trigonum lingualae). It is located in the submandibular triangle. It is limited:
from the front – the posterior border of the mylohyoid muscle, at the back by the tendon of the posterior belly
of the digastric, from the top – the hypoglossal nerve. The floor of the triangle is the hyoglossus, above which
the lingual artery is located.
3. Carotid triangle (trigonum caroticum) is bounded: anterosuperiorly by the posterior belly of the
digastric, anteroinferiorly by the superior belly of the omohyoid, posteriorly by the anterior body of the
sternocleidomastoid muscle. The neurovascular bundle of the neck also runs through this triangle.
4. Muscular triangle (trigonum musculare) is bounded: medially by the midline of the neck,
posterosuperiorly by the superior belly of the omohyoid, posteroinferiorly by the anterior body of the
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sternocleidomastoid. Surgical access to the trachea.
5. Submental triangle (trigonum submentale) is bounded by the anterior bellies of both digastric
muscles (right and left) and the hyoid bone (Fig. 15). Submental lymph nodes lie here.
Sternocleidomastoid region of the neck
Sternocleidomastoid region (regio sternocleidomastoidа), located within the homonymous muscle.
Here, between the two heads of the sternocleidomastoid muscle and the clavicle, the lesser supraclavicular
fossa (fossa supraclavicularis minor) is distinguished. The phrenic nerve runs in the projection of this fossa.
The "phrenicus-symptom" is ascertained here. Positive "phrenicus-symptom" (pain when pressing with the
finger in this fossa) to the right indicates the diseases of gall bladder, bile ducts, and liver.
Lateral cervical region
Lateral cervical region (regio cervicalis lateralis) is bounded: anteriorly by the posterior border of
sternocleidomastoid, posteriorly by the anterior border of the trapezius, inferiorly by the clavicle.
In this area there are two triangles: the scapular-clavicular triangle, and scapular-trapezoidal triangle.
1. Scapular-clavicular triangle (trigonum omoclaviculare) or a large supraclavicular fossa. It is
limited: anteriorly by the posterior edge the sternocleidomastoid muscle, superiorly by the inferior belly of the
omohyoid muscle, infriorly by the clavicle. The trunks of the brachial plexus are formed here.
2. Scapular-trapezoidal triangle (trigonum omotrapesoideum) is limited: anteriorly by the posterior
edge of the sternocleidomastoid muscle, inferiorly by the infrior belly of the omohyoid muscles, posteriorly by
the anterior border of the trapezius muscle. The branches of the cervical plexus emerge in this triangle.
Deep topographical formations of the neck
1. Prescalene space (spatium antescalenum) is limited: anteriorly by the sternohyoid and
sternothyroid muscles, posteriorly by the scalenus anterior muscle, inferiorly by the first rib. Subclavian vein
is located in this space.
2. Interscalene space (spatium interscalenum) is bounded by scalenus anterior muscle anteriorly, by
scalenus medius posteriorly, by the first rib inferiorly. The subclavian artery and brachial plexus are located
there.
3. Scaleno vertebral triangle, or triangle of the vertebral artery (trigonum scaleno-vertebrale seu
trigonum a. vertebralis). Is bounded by the longus colli medially, by the scalenus antrerior muscle laterally,
inferiorly - by the imaginary horizontal line extending from the tubercle of anterior scalene muscle on the first
rib to the intersection with the spine.
FASCIAE OF THE NECK BY V. N. SHEVKUNENKO
1. The first fascia – superficial fascia (facsia superficialis), envelops the neck in the form of a
сase, forming a sheath for the platysma.
2. The second fascia is the superficial layer of the cervical fascia proper (lamina superficialis
fasciae propriae). It covers the entire neck like a case, adheres to the spinous processes of the cervical
vertebrae and the hyoid bone. Going up from the hyoid bone, the second fascia forms the sheath for the
submandibular gland and suprahyoid muscles. Adhering to the edge of the mandible, the fascia continues to
the face into the fascia of the masseteric fascia and the fascia of the parotid gland.
Inferiorly the hyoid bone, the second fascia runs anteriorly the infrahyoid muscles and adheres into the
external surface of the manubrium of sternum and into the clavicle. Heading in the lateral direction, the second
fascia, laminating, forms the sheath for the sternocleidomastoid and trapezius muscles. Going back, it adheres
to the spinous processes of the cervical vertebrae. The second fascia gives rise to two Pirogov's calcars, which
adhere to the transverse processes of the cervical vertebrae.
3. The third fascia of neck is the deep layer of the cervical fascia proper (lamina profunda fasciae
propriae). It stretches between the hyoid bone and two omohyoid muscles. The third fascia forms the sheaths
for infrahyoid muscles and adheres to the posterior surface of the manubrium of the sternum. This fascia is
also called a cervical sail, or richet's aponeurosis.
4. The fourth fascia - endocervical fascia (fascia endocervicalis). It has 2 layers: a) parietal lamina
(lamina parietalis) and b) visceral lamina (lamina visceralis).
a) parietal lamina of the fourth fascia covers all the organs of the neck and forms the sheaths for the
neurovascular bundle of the neck (carotid artery, vagus nerve, internal jugular vein).
b) visceral lamina of the fourth fascia forms the capsule for the internal organs of the neck: the larynx,
trachea, pharynx, esophagus, thyroid gland.
5. The fifth fascia – prevertebral fascia (fascia prevertebralis). Starts from the main part of the
occipital bone and descends in front of the bodies of the cervical vertebrae and prevertebral muscle group,
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adheres to the transverse processes of the cervical vertebrae.
Going down, the fifth fascia extends into the thoracic cavity, continuing there in endothoracis fascia.
Extending laterally, the fifth fascia forms the sheaths for scalene muscle, the neurovascular bundle (subclavian
artery, brachial plexus, subclavian vein), following which it is prolonged to the axillary fossa, where it
continues into the axillary fascia.
Interfascial spaces of the neck, which have important practical value:
1. interaponeurotic suprasternal space (spatium interaponeuroticum suprastemale). It is located on
the manubrium of the sternum and is limited by the second and third fascia. It contains the fiber and the
jugular venous arc (arcus venosus juguli).
2. Gruber's lateral recess (recessus lateralis) , which is formed by the second and third fasciae and is
located behind the lower part of the sternocleidomastoid muscle. It is a blind extroversion that joins with the
spatium interaponeuroticum suprasternale.
3. Pre visceral space (spatium previscerale). It is limited by the layers of the fourth fascia, located
anteriorly to the larynx and trachea, between the third and fourth fascia. This space is joined to the superior
mediastinum.
4. Pretracheal space (spatium pretracheale) is a part of the pre visceral space. It is limited:
posteriorly by the trachea, covered by the visceral lamina of the fourth fascia, anteriorly by the parietal plate of
the fourth fascia and located anteriorly to infrahyoid muscles: sternohyoid and sternothyroid. This space is
joined with the superior and anterior mediastinum and has a practical value, as the pus can spread from the
pretracheal space to he superior and anterior mediastinum. In pretracheal space there are: the isthmus of the
thyroid gland, fiber, a. thyroidea ima, plexus thyroideus impar, pretracheal and paratracheal lymph nodes.
5. Retrovisceral space (spatium retrovisceraae). It lies behind the pharynx and esophagus, is limited
by the fourth and fifth fascia and connects to the superior and posterior mediastinum, which is of practical
importance: in case of retropharyngeal abscess the pus can spread into the posterior mediastinum.
6. Prevertebral space (spatium prevertebrale) is limited: anteriorly by the fifth fascia, posteriorly by
the bodies of the cervical vertebrae. Prevertebral muscles are located here. It is of practical importance – here,
the pus accumulates at tuberculous lesion of the cervical vertebrae in the so-called cold abscesses.
7. Neurovascular sheath (vagina vasonervosa) is a sheath around the neurovascular bundle of the
neck, limited by the parietal plate of the fourth fascia.
8. The space around sternocleidomastoid muscle is formed by the second fascia.
9. Retromandibular fossa (fossa retromandibularis) is located between the posterior edge of the
mandible and the mastoid process. The parotid gland is located here.
FASCIAE OF THE NECK ACCORDING TO THE INTERNATIONAL NOMENCLATURE (PNA,
1999)
Cervical fascia (fascia cervicalis) has three layers: superficial, pretracheal and prevertebral (Fig. 16).
1. Superficial layer (lamina superficialis) of the cervical fascia covers the neck from all sides and
forms fascial sheaths for sternocleidomastoid and trapezius muscles. At the bottom, on the border between the
trunk and the neck, it attaches to the clavicle and the manubrium of the sternum, and at the top - to the inferior
border of the body of the mandible. Posterior on the neck, the superficial layer forms the sheath for the
trapezius muscle and continues along with it into the fascia of the back, ending in the occipital region of the
head.
Superior to the hyoid bone, the superficial layer covers with one its sheet suprahyoid muscles, on the
face the fascia goes into the masseteric and parotid fascia (facsia masseterica, fascia parotidea); the second
sheet goes to the buccinator and the external surface of the pharynx, covering them under the name of
Buccopharyngeal fascia (fascia buccopharyngea). It corresponds to the second fascia by Shevkunenko.
2. Pretracheal layer(lamina pretrachealis) of the cervical fascia is only located in the inferoanterior
section of the neck, is of trapezoidal shape, the most developed between the omohyoid muscles and forms a
sheath for every muscle of the entire group of infrahyoid muscles (sternohyoid, sternothyroid, thyrohyoid and
omohyoid). With the contraction of the omohyoid muscles the pretracheal layer strains in the form of a sail,
facilitating the blood flow through the veins of the neck. Inferiorly the pretracheal layer is attached to the
posterior border of the manubrium of the sternum. Between the pretracheal and prevertebral layers, closer to
the manubrium of the sternum there is suprasternal space (spatium suprasternale), where the jugular venous
arch passes. It corresponds to the third and fourth fasciae by Shevkunenko.
3. Prevertebral layer (lamina prevertebralis) is located posteriorly to the pharynx, covers
anteriorly the muscles located closer to the vertebral column and forms sheaths for the scalene muscles, and
17
continued upward to the external base of the skull. It is separated from the posterior pharyngeal wall by a well
developed layer of loose fiber. Inferiorly, the prevertebral layer goes into the endothoracic fascia (fascia
endothoracica) and on both sides into the axillary fascia (fascia axillaris).
An important feature of the fascia of the neck is that it, forming the sheaths of the veins, closely
connected with their walls by the connective tissue strands, which prevent the walls of veins from collapsing
when there is an injuries. It corresponds to the fifth fascia by Shevkunenko.
THE LIST OF PRACTICAL SKILLS
Name and show muscles of the neck:
Platysma, sternocleidomastoid, digastric, anterior belly, posterior belly, stylohyoid, mylohyoid,
sternohyoid, omohyoid, sternothyroid, thyrohyoid, anterior scalene, middle scalene, posterior scalene.
Topography of the neck
Anterior cervical region, submandibular triangle, carotid triangle scapular-tracheal (muscluar)
triangle, sternocleidomastoid region, lateral cervical region, scapular-clavicular triangle, posterior cervical
region, the Pirogovtriangle, lesser supraclavicular fossa, larger supraclavicular fossa.
MUSCLES OF HEAD (musculi capitis)
Muscles of the head include: facial muscles (mm. faciei); masticatory muscles (mm. masticatorii), as
well as ocular muscles, muscles of middle ear, muscles of tongue, and of soft palate.
Facial muscles
The characteristics of the facial muscles:
a) developed from the second gill arch;
b) origin from the bones of the skull and insert into the skin;
C) most of them are located around the natural openings of the face and with their contraction widen or
narrow them, which results in changing facial expression (mimicry);
g) do not have fasciae (except for the buccinator);
d) are involved in speech, swallowing, chewing, breathing and functioning of the sense organs;
e) are innervated by the facial nerve.
Topographically facial muscles are divided into the muscles of the cranian vault; the muscles of the
ear; the muscles surrounding the eye; the muscles surrounding the nostrils; the muscles surrounding the oral
fissure.
Muscles of the cranial vault
1. Epicranius (m. epicranius). It is composed of:
A. Occipitofrontalis (m. occipitofrontalis) has two bellies: frontal and occipital, between which
epicranial aponeurosis is located.
 Frontal belly (venter frontalis).
Origin: epicranial aponeurosis.
Attachment: the skin of the eyebrows, medial part of the orbicularis oculi.
Function: epicranius moves the scalp due to the dense adhesion of epicranial aponeurosis with the skin and
its loose connection with the bones of the skull. It raises the eyebrows, forms transverse wrinkles on the
forehead, raises the upper eyelid.
 Occipital belly (venter occipitalis).
Origin: the highest nuchal line, the base of the mastoid process of the temporal bone.
Attachment: inserts into the epicranial aponeurosis.
Function: draws the scalp backward, is the backbone of the frontal belly.
B. Temporoparietalis (m. temporoparietalis) is located on the lateral surface of the cranial vault.
Origin: inner surface of the cartilage of the auricle.
Attachment: lateral part of epicranial aponeurosis.
Muscle is a remnant of the ear muscles of mammals. The activity of this muscle is not expressed.
Epicranial aponeurosis (galea aponeurotica) is formed by dense tendon bundles. Epicranial
aponeurosis is connected with the pericraneum very loosely, so it can easily move over the periosteum. The
outer surface of epicranial aponeurosis is tightly connected to the skin with short thickened bundles of
connective tissue. Between these bundles there are inclusions of fat lobules, which causes the elasticity of the
skin. In the temporal region epicranial aponeurosis comes to the superior temporal line, where it is inserted,
continuing then into the temporal fascia, adhering with its external layer. Posteriorly it reaches the external
occipital ridge, anteriorly - to the supraorbital margin of the frontal bone.
The scalp is the skin and epicranial aponeurosis, which are tightly interconnected in the cranial vault,
18
and are easily separated from the periosteum of the skull.
Muscles of the auricle
1. Auricularis anterior (m. auricularis anterior).
Origin: epicranial aponeurosis and temporal fascia.
Attachment: the skin and cartilage of the auricle.
2. Auricularis superior (m. auricularis superior).
Origin: epicranial aponeurosis and temporal fascia.
Attachment: the skin of the auricle at its base.
3. Auricularis posterior (m. auricularis posterior).
Origin: mastoid process of the temporal bone.
Attachment: the skin and the cartilage of the auricle at its base.
The three auricular muscles (anterior, superior and posterior) in humans are vestigial, they practically
do not function.
The muscles surrounding the eye
1. Procerus (m. procerus) (procer means a nobleman).
Origin: the nasal bone.
Attachment: the skin of the forehead (the glabella).
Function: pulls the skin of the forehead down, forming transverse wrinkles in the glabella region.
2.Orbicularis oculi (m. orbicularis oculi) has three parts:
a) orbital part (pars orbitalis);
b) palpebral part (pars palpebralis);
c) deep part (pars lacrimalis, profunda).
Origin: nasal part of the frontal bone, frontal process of the maxilla, posterior lacrimal crest, lacrimal sac, the
medial palpebral ligament.
Attachment: lateral palpebral raphe.
Function: narrows and closes the eye, smooths out the transverse wrinkles on the forehead, expands the
lacrimal sac.
3. Corrugator supercilii (m. corrugator supercilii).
Origin: nasal part of the frontal bone.
Attachment: skin of the suprciliary arches.
Function: draws the eyebrows to the midline of the forehead, forms vertical folds between the eyebrows.
4. Depressor supercilii (m. depressor supercilii).
Origin: lateral surface of the upper part of the nasal bones.
Attachment: skin of the medial part of the eyebrow.
Function: lowers the eyebrow and gently draws it to the middle.
Muscles surrounding the nostrils
1. Nasalis (m. nasalis) has a transverse part (pars transversa) and alar part (pars alaris).
Origin: the alveolar yokes of the upper canine, upper lateral and medial incisors.
Attachment: the transverse part with its tendon connects on the bridge of the nose with the tendon of the same
muscle on the opposite side; the alar part inserts into the skin of the wing of the nose.
Function: narrows the nasal passages, draws the ala of the nose down.
2. Depressor septi nasi (m. depressor septi nasi).
Origin: alveolar tuberosities of the medial upper incisor.
Attachment:the skin of the nasal septum.
Function: draws the nasal septum downwards.
Muscles surrounding the oral fissure
1. Levator labii superioris (m. levator labii superioris).
Origin: the infraorbital margin of the body of the maxilla.
Attachment: skin of the angle of the mouth, the ala of the nose, upper lip, nasolabial fold.
Function: elevates the upper lip and the ala of the nose.
2. Levator labii superioris alaeque nasi (m. levator labii superioris alaeque nasi et).
Origin: frontal process of the maxilla.
Attachment: the skin of the upper lip, the alae of the nose.
Function: elevates the upper lip, draws the ala of the nose upwards.
3.Zigomaticus minor (m. zygomaticus minor).
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Origin: zygomatic bone (its anterior surface).
Attachment: the skin of the nasolabial fold.
Function: deepens the nasolabial fold.
4. Zygomaticus major (m. zygomaticus major).
Origin:t zygomatic bone.
Attachment: the skin of the angle of the mouth and the upper lip.
Function: draws the angle of the mouth upwards and outwards.
5. Rizorius (m. rizorius).
Origin: parotid fascia, masseteric fascia, the skin of the nasolabial fold.
Attachment: the skin of the angle of the mouth.
Function: draws the angle of the mouth outwards.
6. Levator anguli oris (m. levator anguli oris).
Origin: canine fossa of the maxilla.
Attachment: the skin of the angle of the mouth.
Function: draws the angle of the mouth upwards.
7. Depressor anguli oris (m. depressor anguli oris).
Origin: the inferior border of the body of the mandible outwardly from the mental foramen.
Attachment: the skin of the angle of the mouth and the upper lip.
Function: lowers the angle of the mouth.
8. Depressor labii inferioris (m. depressor labii inferioris).
Origin: the body of the mandible, anteriorly to the mental foramen.
Attachment: the skin of the lower lip.
Function: draws the lower lip down.
9. Mentalis (m. mentalis). Is located under the depressor labii inferioris.
Origin: alveolar yokes of the lower incisors and lower canine.
Attachment: the skin of the mentum.
Function: forms the dimples on the skin of the chin, elevates the lower lip, pressing it to the upper one, draws
forward, raises the skin of the chin.
10. Orbicularis oris (m. orbicularis oris). The muscle has two parts: marginal (pars marginalis) and
labial (pars labialis).
Origin: the skin of the angle of the mouth.
Function: narrows and closes the oral fissure. Puckers the lips, draws the lips inward, pressing them to the
teeth.
11. Buccinator (m. buccinator).
Origin: alveolar yokes of the maxillary and mandibular molars, pterygomandibular raphe (raphe
pterygomandibularis), the buccinator crest of the mandible.
Attachment: the skin of the angle of the mouth, the skin of the upper and lower lips.
Function: draws the angle of the mouth outwards, presses the cheeks against the teeth, pushes out the contents
of the oral cavity and the air.
Masticatory muscles
There are four muscles on each side, they insert to the mandible and make it move (Fig. 18, 19).
1. Masseter (m. masseter) has a superficial part (pars superficialis) and the deep part (pars profunda).
Origin:the zygomatic arch, the zygomatic bone.
Attachment: masseteric tuberosity of the mandible, the angle of the mandible.
Function: elevates the mandible, the superficial part is involved in drawing it forward.
2. The temporal muscle (m. temporalis).
Origin: the temporal fossa, the inferior temporal line, temporal fascia.
Attachment: coronoid process of the mandible.
Function: elevates the mandible, with posterior bundles draws it backwards.
3. Lateral pterygoid (m. pterygoideus lateralis). Has two heads: superior and inferior.
Origin: superior head – infratemporal crest, infratemporal surface of the greater wing of the sphenoid;
inferior
head – external surface of the lateral plate of the pterygoid process of the sphenoid, maxillary tuberosity.
Attachment: pterygoid fovea of the condylar process of the mandible, the capsule and the articular disc of the
temporomandibular joint.
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Function: When it contracts unilaterally, it pushes the mandible to the side, opposite to the contracted muscle.
During a bilateral contraction, it pushes the mandible forward.
4. Medial pterygoid (m. pterygoideus medialis).
Origin: pterygoid fossa of the pterygoid process of the sphenoid.
Attachment: pterygoid tuberosity of the mandible.
Function: when it contracts unilaterally, it draws the mandible in the opposite direction, and when contracts
bilaterally – draws it forward.
FASCIAE OF THE HEAD
There is no superficial fascia on the head.
Temporal fascia (fascia temporalis) origins from the superior temporal line, lies outside the temporal
muscle and attaches to the zygomatic arch, dividing above it into two layers: superficial (lamina superficialis)
and deep (lamina profunda), between which there lies the adipose tissue and the temporal venous plexus.
Masseteric fascia (fascia masseterica) covers the masseter and adheres to the zygomatic arch and the
edges of the ramus of the mandible.
Parotid fascia (fascia parotidea) the masseteric fascia proceeds into it. At the anterior edge of the
parotid gland, the fascia splits into two layers, which wrap the gland externally and internally, forming its
capsule. Posterior to the gland, the superficial and deep layers interconnect, the fascia is attached to the
cartilage of the auricle and the mastoid process of the temporal bone.
Buccopharyngeal fascia (fascia buccopharyngea) covers the external surface of the buccinator and
the pharynx, forms pterygomandibular raphe.
THE LIST OF PRACTICAL SKILLS
Name and show muscles of the head:
Epicranius, frontal belly, occipital belly, epicranial aponeurosis, orbicularis oculi, zygomaticus major,
levator labii superioris, levator anguli oris, buccinator, depressor anguli oris, depressor labii inferioris,
orbicularis oris.
Name and show the masticatory muscles:
Temporalis, masseter, lateral pterygoid, medial pterygoid.
MUSCLES OF UPPER LIMB (musculi memdri superioris)
The muscles of the upper limbs are divided into muscles of the shoulder girdle and muscles of the free
part of the upper limb. Muscles of the free part are divided into the muscles of the upper arm, forearm and
hand.
Muscles of the shoulder girdle
1. Deltoid (m. deltoideus) has three parts: clavicular (pars clavicularis), acromial (pars acromialis),
spinal (pars spinalis) (Fig. 20).
Origin: lateral part of the clavicle, the acromion, spine of the scapula.
Attachment: deltoid tuberosity of the humerus.
Function: the clavicular part of the muscle flexes the shoulder, the spinal part extends the shoulder, the
acromial part abducts the shoulder to the horizontal level. During the contraction of the entire muscle, the
upper limb is abducted. When the limbs hang down, the acromial parts of both muscles keep them.
2. Supraspinatus (m. supraspinatus) is located under the deltoid muscle, filling the supraspinous fossa
of the scapula.
Origin: the supraspinous fossa of the scapula and the supraspinous fascia.
Attachment: the greater tubercle of the humerus , articular capsule of the shoulder joint.
Function: abducts the upper limb.
3. Infraspinatus (m. infraspinatus).
Origin: infraspinous fossa of the scapula, infraspinous fascia.
Attachment: the greater tubercle of the humerus , articular capsule of the shoulder joint.
Function: rotates the shoulder outward.
4. Teres minor (m. teres minor).
Origin: lateral border of the scapula, infraspinous fascia.
Attachment: the greater tubercle of the humerus.
Function: rotates the shoulder outward.
5. Teres major (m. teres major).
Origin: posterior surface of the inferior angle of the scapula.
Attachment: crest of the lesser tubercle of the humerus.
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Function: draws the shoulder backwards and laterally, rotates the shoulder to the middle (pronates the
shoulder).
6. Subscapularis (m. subscapularis).
Origin: costal surface of the scapula, the subscapular fascia.
Attachment: the greater tubercle of the humerus , the capsule of the shoulder joint.
Function: rotates the shoulder inwards.
Muscles of the upper arm
They are divided into the muscles of the anterior and posterior compartments of the arm.
To the muscles of the anterior compartment of the arm (compartimentum brachіі anteroior)
belong:
1. Biceps brachii (m. biceps brachіі) has a long and short head.
Origin:the long head (caput longum) – supraglenoid tubercle of the scapula. The tendon of the long head
passes into the cavity of the shoulder joint and after leaving it - in the intertubercular sulcus of the humerus.
Here, the intertubecular tendon sheath (vagina tendinis intertubercularis) is formed. Short head (caput breve)
origins from the coracoid process of the scapula.
Attachment: tuberosity of the radius. A part of the tendon of the biceps brachii forms the bicipital aponeurosis
( aponeurosis m. bicipitis brachii). It is inserted into the antebrachial fascia.
Function: flexes the arm at the shoulder and elbow joints, supinates the forearm if it was before pronated.
2. Brachialis (m. brachialis).
Origin: anterior surface of the humerus below the level of deltoid tuberosity.
Attachment: tuberosity of the ulna, the articular capsule of the elbow joint.
Function: flexion at the elbow joint, draws the capsule of the elbow joint.
3. Coracobrachialis (m. coracobrachialis).
Origin: the coracoid process of the scapula.
Attachment: the upper third of the humerus below the crest of lesser tubercle.
Function: flexion at the shoulder joint.
Muscles of the posterior compartment of the arm (compartimentum brachіі posterior ):
1. Triceps brachii (m. triceps brachii) has long, medial and lateral heads.
Origin: long head (caput longum) – the infraglenoid tubercle of the scapula; lateral head (caput laterale) –
posterior surface of the humerus above the radial groove; medial head (caput mediale) – posterior surface of
the humerus below the radial groove.
Attachment: the olecranon of the ulna.
Function: extension at the elbow and shoulder joints.
2. Anconeus (m. anconeus).
Origin: lateral epicondyle of the humerus, collateral radial ligament, the capsule of the elbow joint.
Attachment: the olecranon of the ulna, posterior surface of the ulna (its upper part).
Function: extends the forearm at the elbow joint, draws its capsule, prevents it from being pinched during
extension.
Muscles of the forearm
Muscles of the forearm are divided into the muscles of the anterior and posterior compartments of the
forearm.
Muscles of the anterior compartment of the forearm (compartimentum antebrachіі anterior):
They mainly function as flexors, they are divided into superficial and deep parts. Superficial part is
formed by the following muscles: brachioradialis, pronator teres, flexor carpi radialis, palmaris longus, flexor
carpi ulnaris. To the deep part belong: flexor digitorum superficialis, flexor digitorum profundus, flexor
pollicis longus and pronator quadratus.
1.Brachioradialis (m. brachioradialis).
Origin: lateral margin of the humerus above its lateral epicondyle and lateral intermuscular septum.
Attachment:the radius above the radial styloid processes.
Function: flexion at the elbow, moves the forearm in the middle position by pronating and supinating it.
2. Pronator teres (m. pronator teres). It has two heads: humeral (caput humerale) and ulnar (caput
ulnare).
Origin: a) humeral head – medial epicondyle of the humerus, lateral intermuscular septum of the arm and
antebrachial fascia; b) ulnar head – coronoid process of the ulna.
Attachment: the upper third of the radius.
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Function: pronates the forearm and provides flexion at the elbow joint.
3. Fexor carpi radialis (m. flexor carpi radialis).
Origin: medial epicondyle of the humerus, antebrachial fascia.
Attachment: palmar surface of the base of the metacarpal II.
Function: provides flexion and abduction of the hand in the wrist joint.
4. Palmaris longus (m. palmaris longus), may be absent.
Origin: medial epicondyle of the humerus, antebrachial fascia. Attachment: the tendon passes into the palmar
aponeurosis (aponeurosis palmaris).
Function:provides flexion at the wrist joint, tenses the palmar aponeurosis.
5. Flexor carpi ulnaris (m. flexor carpi ulnaris). It has two heads: humeral (caput humerale) and ulnar
(caput ulnare).
Origin: a) humeral head: medial epicondyle of the humerus, medial intermuscular septum; b) ulnar head:
upper two-thirds of the posterior surface of the ulna, the olecranon, antebrachial fascia.
Attachment: pisiform.
Function: flexion at the wrist joint and adduction of the hand.
6. Fexor digitorum superficialis(m. flexor digitorum superficialis) has two heads: humeral-ulnar head
(caput humeroulnare) and radial head (caput radiale).
Origin: a) humeral-ulnar head: medial epicondyle of the humerus, coronoid process of the ulna; b) radial head:
the upper part of the palmar surface of the radius.
Attachment: the muscle has four tendons, each of which splits into two crura, which attach to the middle
phalanges of II-V fingers.
Function: flexion of II-V fingers in the metacarpophalangeal and proximal interphalangeal joints.
7. Flexor digitorum profundus(m. flexor digitorum profundus).
Origin: Palmar surface of the ulna, interosseous membrane of the forearm.
Attachment: muscle is divided into four tendons, each of which passes between the crura of the tendons of the
flexor digitorum superficialis and attaches to the bases of the distal phalanges of II-V fingers.
Function: flexion at distal and proximal interphalangeal joints II-V fingers and flexion of the hand.
8. Fexor pollicis longus (m. flexor pollicis lоngus).
Origin: Palmar surface of the radius, interosseous membrane, medial epicondyle of the humerus.
Attachment: the base of the distal phalanx of the thumb.
Function: flexes the thumb.
9. Pronator quadratus (m. pronator quadratus).
Origin: palmar surface of the distal end of the ulna.
Attachment: palmar surface of the distal end of the radius.
Function: prones the forearm (adducts the forearm to the middle).
Muscles of the posterior compartment of the forearm (compartimentum brachіі posterior ):
These include: extensor carpi radialis longus, extensor carpi radialis brevis, extensor carpi ulnars,
extensor digitorum, extensor digiti minimi, abductor pollicis longus, extensor pollicis brevis, extensor pollicis
longus, extensor indicis, supinator.
In the posterior compartment of the forearm there distinguish the lateral part, which includes extensor
carpi radialis longus and extensor carpi radiali brevis.
1. Extensor carpi radialis longus (m. extensor carpi radialis longus).
Origin: lateral margin of the humerus and lateral epicondyle of the humerus, lateral intermuscular septum of
the shoulder.
Attachment: dorsal surface of the base of the metacarpal II.
Function: extension at the elbow and radiocarpal joint, adducts the hand.
1. Extensor carpi radialis brevis (m. extensor carpi radialis brevis).
Origin: lateral epicondyle of the humerus, capsule of the elbow joint.
Attachment: dorsal surface of the base of the metacarpal III.
Function: extension at the radiocarpal joint, adducts the hand.
3. Extensor carpi ulnaris (m. extensor carpi ulnaris).
Origin: lateral epicondyle of the humerus, the posterior border of the ulna, capsule of the elbow joint.
Attachment: the base of the metacarpal bone V.
Function: extension at the radiocarpal joint and abduction of the hand. When extensor carpi radialis and
extensor carpi ulnaris contract simultaniously, the hand extenses at the radiocarpal joint.
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 4. Extensor digitorum (m. extensor digitorum).
Origin: lateral epicondyle of the humerus, capsule of the elbow joint, radial collateral ligament, annular
ligament of the radius.
Attachment: with its four tendons to the II-V fingers. Each tendon is divided into three crura, two of which are
attached to the distal and one to the middle phalanges of the II-V fingers. Between these tendons, on the
dorsum of the hand there are intertendinous connections (connexus intertendineus).
Function: extension of II-V fingers and of the hand in the radiocarpal joint.
5. Extensor digiti minimi (m. extensor digiti minimi).
Origin: lateral epicondyle of the humerus, radial collateral ligament.
Attachment: the distal phalanx of the little finger.
Function: extends the little finger.
8. Abductor pollicis longus (m. abductor pollicis lоngus).
Origin: Palmar surface of the ulna and the radius, interosseous membrane of the forearm.
Attachment: the base of the metacarpal I.
Function: abducts the thumb and the hand.
7. Extensor pollicis brevis (m. extensor pollicis brevis).
Origin: posterior surface of the the radius, interosseous membrane of the forearm.
Attachment: base of the proximal phalanx of the thumb.
Function: extends the thumb and abducts it .
7. Extensor pollicis longus (m. extensor pollicis longus).
Origin: posterior surface of the ulna, interosseous membrane of the forearm.
Attachment: the distal phalanx of the thumb.
Function: extends the thumb.
9. Extensor indicis (m. extensor indicis).
Origin: the lower third of the posterior surface of the ulna.
Attachment: the distal phalanx of the index finger.
Function: extends the index finger.
10. Supinator (m. supinator).
Origin: lateral epicondyle of the humerus, the crest of the supinator, the capsule of the elbow joint, the
collateral radial ligament, the annular ligament of the radius.
Attachment: proximal part of the radius.
Function: rotates the forearm outwards (supination).
Muscles of the hand
Are located primarily on the palmar surface (Fig. 26). Muscles of the hand are divided into 3 groups:
thenar eminence muscles (thenar), hypothenar eminence muscles (hepothenar) and the middle group of
muscles.
1. Abductor pollicis brevis (m. abductor pollicis brevis).
Origin: flexor retinaculum of hand, the tubercle of the scaphoid, the tendon of the abductor pollicis longus,
antrebrachial fascia .
Attachment: base of the proximal phalanx of the thumb.
Function: abducts the thumb, takes part in flexion of the proximal phalanx of the thumb.
2. Fexor pollicis brevis (m. flexor pollicis brevis). Has a superficial head (caput superficiale) and a
deep head (caput profundum).
Origin: superficial head – flexor retinaculum of hand; deep head – trapezium, trapezoid, capitate, base of the I
metacarpal bone.
Attachment: radial and ulnar sesamoid bones, the base of the proximal phalanx of the thumb.
Function: flexion in the metacarpophalangeal joint of the thumb.
3. Adductor pollicis (m. adductor pollicis). Has two heads: oblique head(caput obliquum) and
transverse head (caput transversum).
Origin: oblique head – II-III metacarpals, capitate, radiate carpal ligament; transverse head of the metacarpal
III.
Attachment: ulnar sesamoid bone, the base of the proximal phalanx of the thumb.
Function: adducts the thumb and flexes it in the metacarpophalangeal joint.
4. Opponens pollicis (m. opponens pollicis).
Origin: flexor retinaculum of hand, the tubercle of the trapezium.
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Attachment: radial side of the I metacarpal bone.
Function: opposes the thumb to the little finger.
The medial group of muscles
1. Palmaris brevis (m. palmaris brevis).
Origin: palmar aponeurosis, flexor retinaculum of hand.
Attachment: skin of the medial edge of the palm.
Function: forms the wrinkles on the skin of hypothenar eminence.
2. Abductor digiti minimi (m. abductor digiti minimi).
Origin: tendon of the flexor carpi ulnaris, flexor retinaculum of hand, pisiform.
Attachment: base of the proximal phalanx of the little toe.
Function: abducts the little finger, flexes it in the proximal interphalangeal joint .
3. Flexor digiti minimi brevis (m. flexor digiti minimi brevis).
Origin: flexor retinaculumof hand, hook of hamate.
Attachment: base of the proximal phalanx of the little toe.
Function: flexes and adducts the little finger.
4. Opponens digiti minimi (m. opponens digiti minimi).
Origin: flexor retinaculumof hand, hook of hamate.
Attachment: medial edge of V metacarpal bones.
Function: opposes the little finger to the thumb.
The medial group of muscles
1. Lumbricals (mm. lumbricales). There are four of them, located between the tendons of the flexors
of the fingers.
Origin: radial side of the tendons of the flexor digitorum profundus.
Attachment: dorsal surface of the proximal phalanges of II-V fingers, intertendinous connection of the
extensor digitorum.
Function: flexion of II-V fingers at the metacarpophalangeal joint.
2. Palmar interossei (mm. interossei palmares). Human has three such muscles.
Start: the first muscle – ulnar surface of the base of metacarpal II; the second and third muscles – radial
surface of the base of IV and V metacarpals.
Attachment: intertendinous connection of extensor digitorum of II, IV, V fingers.
Function: adduct the II, IV and V fingers to the III finger (adduct the fingers), provide flexion at
metacarpophalangeal joint and extension at interphalangeal joints of II, IV, V fingers.
3. Dorsal interossei (mm. interossei dorsales). There are four of them.
Origin: adjacent surfaces of the bases of I-V metacarpal bones.
Attachment: proximal phalanges of II-IV fingers: first and second muscles – the lateral edge of the proximal
phalanges of the II-III fingers, the third and fourth muscles – the medial edge of the proximal phalanges of III-
IV fingers.
Function: abduct the II-IV fingers, provide flexion at metacarpophalangeal joint and extension at the
interphalangeal joints of the II-IV fingers.
TOPOGRAPHY AND FASCIAE OF THE UPPER LIMB
Topographical formations of the upper limb:
1. Axillary cavity (сavum axillare) – has four walls and two openings.
Walls:
a) anterior– pectoralis major and minor (mm. pectoralee major et minor);
b) posterior – latissimus dorsi (m. latissimus dorsi), teres major (m. teres major), subscapularis (m.
subscapularis);
C) medial - serratus anterior (m. serratus anterior);
g) lateral – humerus, coracobrachialis (m. coracobrachialis), short head of the biceps brachii (caput
breve m. bicipitis brachii).
Openings of the axillary cavity:
a) the superior opening is limited by the clavicle, the first rib, the superior border of the scapula;
b) the inferior opening is limited: anteriorly by the inferior border of the pectoralis major; posteriorly
by thefree border of the latissimus dorsi; medially by the anterior serratus; laterally by the coracobrachialis
and the short head of the biceps.
In the thoracic area there is distinguished:
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 A. Clavipectoral triangle (trigonum clavipectorale).
This triangle is limited: superiorly by the clavicle, inferiorly by the superior border of the pectoralis
minor, medially by the midline of the anterior thoracic wall.
B. Pectoral triangle (trigonum pectoralе) is limited by the borders of the pectoralis minor.
C. Subpectoral triangle (trigonum subpectorale) is limited: superiorly by the inferior border of the
pectoralis minor, inferiorly by the inferior border of the pectoralis major, laterally by the anterior border of the
deltoid.
On the posterior wall of the axillary cavity there are two openings:
a) quadrangular opening (foramen quadrilaterum) is limited: superiorly by the subclavius, inferiorly
by the teres major, medially by the long head of the triceps brachii, laterally by the surgical neck of the
humerus;
b ) triangular opening (foramen trilaterum) is limited: superiorly by the subclavius, inferiorly by
theteres major, laterally by the long head of the triceps brachii.
2. Deltoidopectoral groove (sulcus deltoideopectoralis) is limited by the superior border of the
pectoralis major and the anterior border of the deltoid. Reaching the clavicle, it goes into the clavipectoral
triangle.
In the anterior region of arm there is medial bicipital groove (sulcus bicipitalis medialis) bounded by
medial borders of the brachialis and the biceps and the lateral bicipital groove (sulcus bicipitalis lateralis),
bounded by the lateral borders of the brachialis and the biceps.
3. Canalis n.radialis, s. canalis humeromuscularis, s. canalis spiralis- is the canal of the radial nerve,
bounded by the radial groove, sulcus n. radialis, on the humerus and triceps brachii. The canal has two
openings:
a) upper is located on the border of the upper and middle thirds of the arm from the medial side and is
bounded by the medial and lateral heads of triceps brachii;
b) lower opening is located on the lateral side, on the border of the middle and lower thirds of the arm
and is bounded by the brachialis and brachioradialis. Through the canal pass n. radialis, and. profunda brachii,
w. profundae brachii.
4. Cubital fossa (fossa cubiti). It is bounded by the brachialis from above; by the brachioradialis from
below and laterally; by the pronator teres below and medially.
There are two grooves in the cubital fossa: 1) anterior medial cubital groove (sulcus cubitalis anterior
medialis) between the brachialis and the pronator teres; 2) anterior lateral cubital groove (sulcus cubitalis
anterior lateralis) between the brachialis and the brachioradialis.
5. Canalis ulnaris – ulnar canal, formed by the capsule of the elbow joint and the two heads of the
flexor carpi ulnaris, m. flexor carpi ulnaris. There pass two n. ulnaris.
6. Sulcus radialis – radial groove, is bounded by the brachioradialis and flexor carpi radialis. In the
radial groove there pass a. radialis, radial veins, the superficial branch of n. radialis.
7. Sulcus medianus – median groove, bounded by the flexor carpi radialis and flexor digitorum
superficialis. N. мedianus passes there.
8. Sulcus ulnaris – ulnar groove is bounded by the flexor digitorum superficialis and flexor carpi
ulnaris. There pass a. ulnaris, ulnar veins, n. ulnaris.
9. Scatula anathomica (scatula anathomica) is bounded: laterally by the tendons of abductor pollicis
longus and extensor pollicis brevis; medially by the tendon of extensor pollicis longus. There passes a.
radialis.
10. Pirogov's space. It has two walls: the anterior wall is formed by flexor digitorum profundus and
flexor pollicis longus; the posterior wall is formed by the pronator quadratus.
11. Carpal canal (сanalis carpalis) is formed by the extensor retinaculum and carpal groove (sulcus
carpi). The common synovial sheath of the flexor muscles, the sheath of the tendon of the flexor pollicis
longus, and the median nerve are located here.
FASCIA OF THE UPPER LIMB
Deltoid fascia (fascia deltoidea) covers the deltoid vuscle from the inside and on the outside. In the
thoracic area the deltoid fascia continues into the pectoral fascia. On the border of the deltoid muscle and
muscles of the arm it continues into the brachial fascia.
The axillary fascia (fascia axillaris) covers the axillary fossa and is the continuation of the
prevertebral layer of the fascia of the neck.
Brachial fascia (fascia brachii) covers the entire shoulder as a case. It has two intermuscular septa:
26
medial intermuscular septum of the arm (septum intermusculare brachii mediale) and lateral intermuscular
septum of the arm (septum intermusculare brachii laterale). They adhere to the medial and lateral borders of
the humerus. Thus, there form two bony-fibrous cases on the shoulder.
Antebrachial fascia (fascia antebrachii) is the continuation of the brachial fascia. It adheres to the
olecranon, from which fascial bundles adhere to the medial epicondyle of the humerus, covering the ulnar
nerve on the outside.
The antebracheal fascia covers the forearm in the form of a case.
In the final compartment of the forearm, the fascial fibers go circularly and the fascia adheres to the
ulnar and radial styloid processes. This part of the fascia thickens, forming on the anterior surface the flexor
retinaculum (retinaculum musculorum flexorum), and on the posterior one – extensor retinaculum
(retinaculum musculorum extensorum). From the extensor retinaculum there go septa, which adhere to the
dorsal surface of the bones of the forearm, forming six dorsal carpal tendinous sheaths (vaginae tendinum
сarpales dorsales), in which tendons of the extensors are located.
On the dorsum of the hand there is the dorsal fascia of the hand (fascia dorsalis manus). Between its
superficial and deep layers there lie tendons of the muscles extensors of digits, blood vessels and nerves. The
fascia adheres to the dorsal surface of the metacarpal bones.
On the palmar surface of the hand there is the palmar aponeurosis (aponeurosis palmaris). It origins
from the flexor retinaculum, is divided into four bundles, between which the transverse fasciculi are located
(fasciculi transversi). The palmar aponeurosis ends in the region of the metacarpophalangeal joints. In the
lateral and medial directions palmar aponeurosis becomes thinner and continues in the form of a thin fascia,
which covers the muscles of the thenar eminence and hypothenar eminence.
From the palmar aponeurosis to the skin of the palm there go connective fibers, which divide the
subcutaneous fat into individual cells like a honeycomb. Therefore, the purulent process spreads here in depth,
there are often focal necrosis.
On the digits of the hand, the fascia adheres to the lateral borders of the phalanges, forming fibrous
digital sheaths of digits of hand (vaginae fibrosae digitorum manus). In every sheath there distinguish the
anular part of the fibrous sheath (pars anularis vaginae fibrosae) – in the region of the bodies of phalanges,
and cruciform part of the fibrous sheaths (pars cruciformis vaginae fibrosae) – in the joints.
On the palmar surface of the fingers, from the skin to the fibrous sheaths of the tendons and periosteum
of the phalanges there go connective-tissue fibers, forming cells. In cells there accumulates adipose tissue.
Therefore, the purulant process here spreads not just superficially, but in depth.
FASCIA OF THE UPPER LIMB
On the palmar surface of the hand there is the common flexor sheath of hand (vagina tendinis
communis musculorum flexorum), and the tendonous sheath of the flexor pollicis longus.
The common flexor sheath of hand contains eight tendons of the flexor digitorum superficialis and
flexor digitorum profundus. Proximally, it protrudes 1-2 cm above from the flexor retinaculum, distally it
reaches the middle of the metacarpal bones and on the little finger it spreads to the base of the distal phalanx
(Fig. 28).
The common flexor sheath of hand sometimes is connected to the joint cavity of the wrist joint, so the
inflammation of the tendonous sheath (tenosynovitis) of the little finger may be complicated by purulent
arthritis of the wrist joint.
The tendonous sheath of the flexor pollicis longus (vagina tendinis musculi flexoris pollicis longi)
protrudes proximally 1-2 cm above from the flexor retinaculum, distally it reaches the base of the distal
phalanx of the thumb. There can be the connection between the common flexor sheath of the hand and the
tendonous sheath of the flexor pollicis longus. In such cases, the so-called U-shaped phlegmon can occure
when there is the tenosynovitis of the I or V finger.
From the middle of the metacarpal to the metacarpophalangeal joints tendons of flexor digitalis
superficialis and profundus of II-IV fingers do not have synovial sheaths.
There are synovial sheaths of digits of hand (vaginae synoviales digitorum manus)on the palmar
surface of the II-IV fingers. Each sheath contains two tendons: the tendon of the flexor digitalis superficialis,
and the tendon of the flexor digitalis profundus. These sheaths continue from the metacarpophalangeal joints
to the distal phalanges of the II-IV fingers.
There are six tendonous sheaths on the dorsum of the hand (Fig. 29):
a) the tendonous sheath of the abductor pollicis longus and extensor pollicis brevis (vagina
tendinum musculi abductoris longi et extensoris pollicis brеvis);
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 b) the tendonous sheath of the extensors carpi radialis longus and brevis (vagina tendinum musculi
extensorum carpi radialium);
c) the tendonous sheath of the extensor pollicis longus (vagina tendinis musculi extensoris pollicis
longi);
d) tendonous sheath extensor digitorum and extensor indicis (vagina tendinum musculi extensoris
digitorum et extensoris indicis);
e) the tendonous sheath of the extensor digiti minimi (vagina tendinis m.usculi extensoris digiti minimi);
f) the tendonous sheath of the ulnar extensor carpi ulnaris (vagina tendinis musculi extensoris carpi
ulnaris).
THE LIST OF PRACTICAL SKILLS
Name and show muscles of the upper limb:
1 – muscles of the shoulder girdle:
Deltoid, supraspinatus, infraspinatus, teres minor, teres major, subscapularis.
2 - muscles of the arm
Biceps brachii and its aponeurosis, bicipital aponeurosis, lacertus fibrosus; coracobrachialis,
brachialis, triceps brachii, anconeus.
3 - muscles of the forearm
Pronator teres, flexor carpi radialis, palmaris longus, flexor carpi ulnaris, flexor digitorum
superficialis, flexor digitorum profundus, flexor pollicis longus, pronator quadratus, brachioradialis,
extensor carpi radialis longus, extensor carpi radialis bravis, extensor digitorum, extensor digiti minimi,
extensor carpi ulnaris, supinator, abductor pollicis longus, extensor pollicis brevis, extensor pollicis
longus, abductor pollicis brevis.
4 - muscles of the hand
Palmaris brevis, abductor pollicis brevis, flexor pollicis brevis, opponens pollicis, adductor pollicis,
abductor digiti minimi, flexor digiti minimi brevis, opponens digiti minimi, lumbricals, dorsal
interossei, palmar interossei.
Name and show topographical formations of the upper limb:
auxillary fossa, walls of auxillary fossa, quadrangular opening, triangular opening, lateral bicipital
groove, medial bicipital groove, cubital fossa, extensor retinaculum, flexor retinaculum, palmar
aponeurosis, carpal canal, cubital, radial and median grooves of the forearm.
MUSCLES OF THE LOWER LIMB (musculi membri іnferioris)
Muscles of the lower limb are divided into muscles of the pelvis and muscles of the free part of the
lower limb. Muscles of the free part are divided into muscles of the thigh, leg and foot.
MUSCLES OF THE PELVIS
EXTERNAL MUSCLES OF THE PELVIS:
1. Gluteus maximus (m. gluteus maximus).
Origin: the external surface of the ala of ilium, iliac crest, posterior gluteal line, thoracolumbar fascia,
posterior surface of the sacrum and coccyx, sacrotuberous ligament.
Attachment: gluteal tuberosity of the femur, the muscle goes into the iliotibial tract (tractus iliotibialis), which
attaches to the lateral condyle of the tibia.
Function: extension in the hip joint, external rotation of the thigh; if the lower limb is fixed, it extends the
trunk, maintains the balance of the body, preventing the trunk from leaning forward; keeps the trunk in an
upright position; by straining the iliotibial track it keeps the knee joints in a straightened position (Fig. 30, 31).
2. Gluteus medius (m. gluteus medius).
Origin: the external surface of the ala of ilium (between anterior and posterior gluteal lines).
Attachment: greater trochanter of femur.
Function: abducts the thigh; medially rotates it (if the anterior part of the muscle contracts); rotates the thigh
outwards (if the posterior part of the muscle contracts). When the lower limb is fixed, it tilts the pelvis to its
side.
3. Gluteus minimus (m. gluteus minimus).
Origin:the external surface of the ala of ilium.
Attachment: greater trochanter of femur.
Function: abducts the thigh; rotates the thigh inward (if the anterior part of the muscle contracts); externally
rotates the thigh (if the posterior part of the muscle contracts).
4. Tensor fasciae latae (m. tensor fasciae latae).
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Origin: anterior superior iliac spine.
Attachment: fuses into the broad fascia of the thigh, is continuous with the iliotibial tract.
Function: it is the tensor of the broad fascia of the thigh, flexion in the hip joint and abduction. Flexion in the
knee joint and rotation of the limb outwards.
5. Quadratus femoris (m. quadratus femoris).
Origin: the ischial tuberosity of the pelvic bone.
Attachment: Intertrochanteric crest of the femur.
Function: external rotation of the hip (Fig. 31).
6. Obturator externus (m. obturatorius externus).
Origin: external surface of the pelvic bone around obturator foramen, obturator membrane.
Attachment: trochanteric fossa, the capsule of the hip joint.
Function: external rotation of the thigh.
7. Superior gemellus (m. gemellus superior).
Origin: ischial spine.
Attachment: trochanteric fossa of the femur.
8. Inferior gemellus (m. gemellus inferior).
Origin: ischial tuberosity.
Attachment: trochanteric fossa.
Function: both gemellus muscles rotate the thigh externally.
INTERNAL MUSCLES OF THE PELVIS:
1. Iliopsoas (m. iliopsoas) has two heads, one of which is psoas major, the other – iliacus.
A) Psoas major (m. psoas major).
Origin: the body of XII thoracic and four upper lumbar vertebrae, transverse processes of lumbar vertebrae.
B) Iliacus (m. iliacus).
Origin: iliac fossa of the hip bone, anterior superior and anterior inferior iliac spines, inner lip of the iliac
crest.
Attachment: iliacus and psoas major insert into the lesser trochanter of the femur with a joint tendon, which
passes through the muscular lacuna.
Function: flexion at the hip joint and external rotation of the thigh. If the lower limb is fixed, it bends the
lumbar part of the spine to the side of the contracted muscle, in case of a bilateral contraction it tilts the pelvis
and trunk forward.
2.Psoaos minor (m. psoas minor).
Origin: XII thoracic and I lumbar vertebrae.
Attachment: the tendon is continuous into the iliac fascia, ending in the region of the iliopubical ramus.
Function: tensor of the iliac fascia.
3. Piriformis (m. piriformis).
Origin: pelvic surface of the sacrum externally from the pelvic sacral foramen. Leaves the pelvis through the
greater sciatic foramen.
Attachment: greater trochanter of femur.
Function: abduction and external rotation of the thigh. If the lower limb is fixed, it tilts the pelvis to its side,
in case of the bilateral contraction, it tilts the pelvis forward.
4. Obturator internus (m. obturatorius internus).
Origin: inner surface of the hip bone around the obturator foramen, the inner surface of obturator membrane.
Leaves the pelvis through the lesser sciatic foramen.
Attachment: trochanteric fossa of the femur.
Function: external rotation of the thigh.
MUSCLES OF THIGH
Muscles of thigh are divided into muscles of anterior, medial and posterior compartments of thigh.
MUSCLES OF THE ANTERIOR COMPARTMENT OF THIGH
1. Quadriceps femoris (m. the quadriceps femoris) has four heads: rectus femoris, vastus medialis,
vastus lateralis, vastus intermedius (Fig. 33, 34).
A) Rectus femoris (m. rectus femoris).
Origin: anterior inferior iliac spine.
B) Vastus medialis (m. vastus medialis).
Origin: medial lip of the linea aspera of the femur.
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 C) Vastus lateralis (m. vastus lateralis).
Origin: intertrochanteric line, greater trochanter, lateral lip of the linea aspera of the femur.
D) Vastus intermedius (m. vastus intermedius).
Origin: anterior surface of the femur until the intertrochanteric line.
Attachment: patella, the tendon is continuous into the patellar ligament, which inserts into the tibial
tuberosity.
Function: flexion at the hip joint and extension in the knee joint.
2. Sartorius (m. sartorius).
Origin: anterior superior iliac spine.
Attachment: deep fascia of leg, tibial tuberosity.
Function: flexion at the hip joint, external rotation of the thigh, flexion at the knee joint, internal rotation of
the leg.
MUSCLES OF THE MEDIAL COMPARTMENT OF THIGH
1. Pectineus (m. peсtineus).
Origin: superior pubic ramus and the pubic crest.
Attachment: pectineal line of femur.
Function: flexion and adduction in the hip joint.
2. Adductor longus (m. adductor longus).
Origin: superior pubic ramus.
Attachment: the middle third of the medial lip of linea aspera of the femur.
Function: flexion and adduction in the hip joint.
3. Adductor brevis (m. adductor brevis).
Origin: inferior pubic ramus.
Attachment: superior part of the medial lip of linea aspera of the femur.
Function: flexion and adduction in the hip joint.
4. Adductor magnus (m. adductor magnus).
Origin: pubic and ischial rami, the ischial tuberosity.
Attachment: the entire length of the median lip of linea aspera of the femur
Function: flexion and adduction in the hip joint.
5. Gracilis (m. gracilis).
Origin: inferior pubic ramus.
Attachment: deep fascia of leg, tibial tuberosity. Function: adduction of the thigh, flexion at the knee joint
with medial rotation of the leg.
MUSCLES OF THE POSTERIOR COMPARTMENT OF THIGH
1. Semitendinosus (m. semitendinosus).
Origin: ischial tuberosity.
Attachment: tibial tuberosity, deep fascia of leg. Tendons of semitendinosus, sartorius and gracilis muscles
form an aponeurosis in the point of their insertion.
Function: extension at the hip joint, flexion at the knee joint, medial rotation of the leg.
2. Semimembranosus (m. semimembranosus).
Origin: ischial tuberosity.
Attachment: medial process of the tibia, popliteal fascia, oblique popliteal ligament.
Function: extension at the hip joint, flexion at the knee joint, medial rotation of the leg.
3. Biceps femoris (m. biceps femoris). Has a long and a short heads:
a) the long head (caput longum) origins at the ischial tuberosity;
b) short head (caput breve) origins at the medial third of the lateral lip of the linea aspera of femur,
lateral intermuscular septum (septum intermusculare laterale).
Attachment: head of the fibula.
Function: extension at the hip joint, flexion at the knee joint, rotation of the leg outward.
If the leg is fixed, all the muscles of the posterior compartment of thigh are extensors of the trunk, they
are synergists of gluteus maximus.
At the point of insertion of gracilis, semitendinosus, semimembranosus and sartorius muscles there
form: a) superficial "goose foot" pes anserinus superficialis, formed by the tendons of sartorius, gracilis and
semitendonous muscles; b) deep "goose foot", pes anserinus profundus, formed by the three plates of the
tendon of the semimembranosus: one is inserted on the medial condyle of the tibia; the second inserts on the
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popliteal fascia, and the third is continuous into the oblique popliteal ligament.
MUSCLES OF LEG
Muscles of leg are divided into the muscles of the anterior, lateral and posterior compartments of the
leg.
MUSCLES OF THE ANTERIOR COMPARTMENT OF LEG
1. Tibialis anterior (m. tibialis anterior).
Origin: lateral condyle, lateral surface of tibia, interosseous membrane of the leg, deep fascia of the leg.
Attachment: medial cuneiform bone, base of the first metatarsal bone. Function: extends the foot at the
talocrural joint (elevates the foot), elevates the medial border of the foot, adducts the foot. If the foot is fixed,
it tilts the leg forward.
2. Extensor digitorum longus (m. extensor digitorum lоngus).
Origin: lateral condyle of the tibia, the head and anterior border of the fibula, interosseous membrane of the
tibia, deep fascia of the leg.
Attachment:with its four tendons to II-V toes, on each toe the tendon is divided into three crura, two of which
are inserted on the distal phalanx, and one on the middle phalanges of II-V toes. The fifth tendon of this
muscle is inserted on the base of V metatarsal bone. A bundle of muscle fibers, which the fifth tendon forms
here, is called fibularis tertius (m. fibularis tertius).
Function: extends the II-V toes, extends the foot in the talocrural joint (elevates the foot), raises the lateral
border of the foot, abducts the foot. If the foot is fixed, it tilts the leg forward.
7. Extensor hallucis longus (m. extensor hallucis longus).
Origin: medial surface of the tibia, interosseous membrane of the leg.
Attachment: the distal phalanx of the great toe.
Function: extends the foot at the talocrural joint, raises its medial border, extends the great toe. If the foot is
fixed, it tilts the leg forward.
MUSCLES OF THE LATERAL COMPARTMENT OF LEG
1. Fibularis longus (m. fibularis longus).
Origin: the head and the superior third of the lateral surface of the fibula, anterior and posterior intermuscular
septa of the leg, deep fascia of the leg. Attachment: medial cuneiform bone, base of the first metatarsal bone.
Function: lowers the medial border of the foot, abducts and flexes the foot at the talocrural joint.
2. Fibularis brevis (m. fibularis brevis).
Origin: the medial third of the lateral surface of the fibula, anterior and posterior intermuscular septa of the
leg.
Attachment: tuberosity of the V metatarsal bone.
Function: elevates the medial border of the foot, abducts and flexes the foot at the talocrural joint.
MUSCLES OF THE SUPERFICIAL PART OF THE POSTERIOR COMPARTMENT OF LEG
1. Triceps surae (m. triceps surae). It consists of the gastrocnemius, which lies superficially, and
soleus, located under it.
A). Gastrocnemius (m. gastrocnemius) has two heads: medial and lateral.
Origin: medial head (caput mediale) origins above the medial condyle of the femur; lateral head (caput
laterale) origins above the lateral condyle of the femur.
Attachment: calcaneal tuberosity .
B) Soleus (m. soleus).
Origin: head and the upper third of the posterior surface of the fibula, soleal line, and tendinous arch of the
soleus.
Attachment: all heads of the triceps surae are continuous into the Achilles tendon (tendo calcaneus), which is
inserted on the calcaneal tuberosity.
Function: flexes the foot in the talocrural joint, adducts the foot, rotates it externally. Flexion in the knee
joint.
2. Plantaris (m. plantaris).
Origin: above the lateral condyles of the femur, capsule of knee joint.
Attachment: fused with Achilles tendon.
Function: tenses the capsule of the knee joint.
MUSCLES OF THE DEEP PART OF THE POSTERIOR COMPARTMENT OF LEG
1. Popliteus (m. popliteus).
Origin: lateral epicondyle of the femur, capsule of the knee joint.
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Attachment: popliteal line of the tibia.
Function: flexion in the knee joint, rotates the tibia medially, if the leg and the foot are fixed, it helps flexion
in the knee joint
2.Flexor digitorum longus (m. flexor digitorum lоngus).
Origin: posterior surface of tibia, deep fascia of the leg.
Attachment:is divided into four tendons to II-V toes, each tendon passes between the two crura of the tendons
of the flexor digitorium brevis, are inserted into the distal phalanges of II-V fingers.
Function: flexes the foot in the talocrural joint, rotates it externally, flexes II-V toes. Helps to strengthen the
arch of foot.
7. Flexor hallucis longus (m. flexor hallucis longus).
Origin: posterior surface of the fibula, interosseous membrane of the tibia, the posterior intermuscular septum
of the leg.
Attachment: the distal phalanx of the great toe.
Function: flexes the great toe, flexes the foot in the talocrural joint, adducts the foot and rotates it externally.
Fixes the medial part of longitudinal arch of foot.
4. Tibialis postenor (m. tibialis posterior).
Origin: tibia and fibula, interosseous membrane of the tibia.
Attachment: navicular, three cuneiform bones, bases of II-V metatarsal bones.
Function: flexes the foot in the talocrural joint, adducts the foot, rotates it externally, strengthens the arch of
the foot.
MUSCLES OF FOOT
The muscles of the foot are located on the dorsal and plantar surfaces of the foot.
MUSCLES OF THE DORSAL SURFACE OF THE FOOT
2. Extensor digitorum brevis (m. extensor digitorum brevis).
Origin: calcaneus (lateral and superior surfaces of the anterior part of the bone).
Attachment: is divided into three tendons to the II-IV fingers, fusing together with the tendon of extensor
digitorum longus.
Function: extends the II-IV fingers, abducts them.
2. Extensor hallucis brevis (m. extensor hallucis brevis).
Origin: anterior superior surface of the calcaneus.
Attachment: the distal phalanx of the great toe.
Function: extends the great toe.
3. Dorsal interossei (mm. interossei dorsales). There are four of them.
Origin:with two heads from the contiguous surfaces of the two adjacent metatarsal bones.
Attachment: base of the proximal phalanx of the II-IV toes (first and second muscles, respectively, to the
medial and lateral surfaces of the proximal phalanx of second toe; the third and fourth muscles to the lateral
surface of the proximal phalanx of, respectively, III and IV toes), all four tendons insert into the dorsal
phalanges of II-IV toes.
Function: the first muscle draws the second toe to the middle; the second, third and fourth muscles draw the
II-IV toes laterally; all four muscles provide flexion in metatarsophalangeal joints and extension in
interphalangeal joints of the II-IV toes.
MUSCLES OF THE PLANTAR SURFACE OF THE FOOT
Muscles which are located on the palmar surface of the foot are divided into medial, lateral and middle
groups.
MEDIAL GROUP
1. Abductor hallucis (m. abductor hallucis).
Origin: medial process of the calcaneal tuberosity, tuberosity of the navicular, flexor retinaculum.
Attachment: medial sesamoid bone, the base of the proximal phalanx of the great toe.
Function: medially abducts the great toe.
2. Fexor hallucis brevis (m. hallucis brevis). It has a medial and lateral heads (caput caput mediale et
laterale).
Origin: medial cuneiforme bone, navicular, the tendon of tibialis posterior, long plantar ligament.
Attachment: medial and lateral surfaces of the base of the proximal phalanx of the great toe, medial and lateral
sesamoid bones.
Function: flexion in the metatarsophalangeal joint of the great toe.
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 3. Adductor hallucis (m. adductor hallucis). This muscle has an oblique and transverse heads.
Origin: oblique head (caput obliquum) – lateral cuneiform bone, base of II-V metatarsal bones, long plantar
ligament; transverse head (сaput transversum) capsules of II-V metatarsophalangeal joints, distal ends of II-V
metatarsal bones, plantar aponeurosis, deep transverse metatarsal ligaments.
Attachment: base of the proximal phalanx of the great toe, lateral sesamoid bone.
Function: adducts the great toe and flexes it, narrows the foot (transverse head), shortens the foot (oblique
head).
LATERAL GROUP
1. Abductor digiti minimi (m. abductor digiti minimi).
Origin: lateral and medial processes of calcaneal tuberosity, tuberosity of the fifth metatarsal bone, plantar
aponeurosis.
Attachment: base of the proximal phalanx of the little toe.
Function: abducts the little toe, flexion at metatarsophalangeal joint.
2. Flexor digiti minimi brevis (m. flexor digiti minimi brevis).
Origin: the base of the fifth metatarsal bone, long plantar ligament, tendonous sheath of fibularis longus.
Attachment: base of the proximal phalanx of the little toe.
Function: flexion in the metatarsopophalangeal joint of the little toe.
MIDDLE GROUP
2. Flexor digitorum brevis (m.flexor digitorum brevis).
Origin: tuberosity of the calcaneus, plantar aponeurosis.
Attachment: the muscle has four tendons, each of which splits into two crura, which insert to both sides of the
middle phalanges of II-V toes.
Function: flexion at proximal interphalangeal joints of II-V fingers, strengthens the longitudinal arches of the
foot, shortening the foot.
2. Quadratus plantae (m. quadratus plantae).
Origin: calcaneus, long plantar ligament.
Attachment: lateral border of the tendon of the flexor digiti longus.
Function: regulates the action of the flexor digiti longus, drawing its tendon laterally, participates in flexion
of the distal interphalangeal joints of II-V toes.
3. Lumbricals (mm. lumbricales) in the number of four.
Origin: four tendons of flexor digiti longus, the first muscle with one its head from the medial border of the
tendon of the second toe, and the rest muscles with two heads from two adjacent tendons.
Attachment: medial edge of the proximal phalanx of II-V toes.
Function: flexion at metatarsophalangeal joints of II-V toes, extension at interphalangeal joints, adduction of
II-V toes to the great toe.
4. Plantar interossei (mm. interossei plantares). There are three of them in II, III, IV in intermetatarsal
spaces.
Origin: medial surface of III, IV, V metatarsal bones.
Attachment: base of proximal phalanges III-V toes.
Function: adduct III, IV, V toes to the second toe, flexion at metatarsophalangeal joints and extension at
interphalangeal joints of III-V toes.
TOPOGRAPHY AND FASCIA OF THE LOWER LIMB
THE TOPOGRAPHY OF THE LOWER LIMB
1. Suprapiriform foramen (foramen suprapiriforme). The foramen is in the gluteal region and is a slit
above the piriformis muscle.
2. infrapiriform foramen (foramen infrapiriforme). The foramen is in the gluteal region and is a slit
below the piriformis muscle.
3. Obturator canal (canalis obturatorius). It is formed by the obturator groove on the pelvic bone
superiorly, obturator membrane, obturator internus and externus
4. There is muscular space (lacuna musculorum) on the anterior surface of the thigh under the inguinal
ligament. It is bounded by the inguinal ligament anteriorly and superiorly; by ilium inferiorly and posteriorly;
by iliopectineal arch medially. Iliopsoas and femoral nerves go through the muscular space onto the thigh (Fig.
39).
5. Vascular space (lacuna vasorum). It is located medially in relation to muscular space on the anterior
surface of the thigh below the inguinal ligament. Vascular space is bounded by the inguinal ligament
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anteriorly and superiorly; by the superior pubic ramus below and behind; by iliopectineal arch externally; by
lacunar ligament (lig. lacunare) medially..
Femoral artery and femoral vein pass through the vaslular space.
6. Femoral triangle (trigonum femorale) is bounded by the inguinal ligament and sartorius from above,
by adductor longus medially.
7. Iliopectineal sulcus (sulcus iliopectineus). It is bounded by the iliopsoas laterally, by pectineus
medially.
8. Anterior femoral groove (sulcus femoralis anterior). It is bounded by adductors longus and magnus
medially, by vastus medialis laterally.
9. Adductor canal (canalis adductorius) has three walls: lateral, formed by vastus medialis, medial,
formed by adductor magnus, and anterior, formed by femoral septum.
Femoral artery and vein, as well as saphenous nerve, run in the adductor canal.
10. Popliteal fossa (fossa poplitea). It is bounded by the biceps femoris superiorly and externally, by the
semitendinosus and semimembranosus superiorly and medially, bottom, by the lateral head of gastrocnemius
posteriorly and externally, by the medial head of gastrocnemius posteriorly and medially. The bottom of the
fossa is formed by the popliteal surface of the femur and the capsule of the knee joint.
In the fossa, there is a neurovascular bundle, formed by the tibial nerve, popliteal vein, popliteal artery;
they are located in the direction from back to front and from the side to the middle.
11. Cruropopliteal canal (сanalis cruropopliteus). Located on the posterior surface of the leg. Has two
walls and three openings. Walls: posterior, formed by soleus, and anterior, formed by tibialis postenor, flexor
digitorum longus, flexor hallucis longus.
The three openings of cruropopliteal canal are: superior (entering), bounded by the popliteus in the front,
and tendineous arch of the soleus in the back. The anterior opening (exiting) is in the upper part of the
interosseous membrane of the leg. The infrior (exiting) opening is located on the medial surface of the leg at
the point where triceps surae is continuous into the calcaneus (Achilles ) tendon.
12. Superior musculoperoneal canal (сanalis musculo-peroneue superior), located laterally, occupies
the upper and middle thirds of the leg. It is bounded by the fibula and two heads of fibularis longus.
13. Inferior musculoperoneal canal (сanalis musculo-peroneue inferior), occupies the middle and
lower thirds of the leg. It is formed by the fibula and flexor hallucis longus, as well as by tibialis postenor. It is
the branch of cruropopliteal canal.
14. Medial plantar sulcus (sulcus plantaris medialis). It is bounded by the flexor digitorum brevis and
abductor hallucis.
14. Lateral plantar sulcus (sulcus plantaris lateralis). It is bounded by the short flexor of digits of the
foot and the abductor muscle of the little toe.
FASCIA OF THE LOWER LIMB
1. Iliac fascia (fascia iliaca) covers the iliopsoas muscle, adheres to the lateral part of the inguinal
ligament, separating from which, adheres to iliopubic ramus. This forms the iliopectineal, which divides the
space under the inguinal ligament into muscular and vascular spaces.
2. Fascia lata (fascia lata) envelopes all the muscles of thigh. Below the inguinal ligament fascia lata
splits into superficial and deep layers. They are located anteriorly and posteriorly to femoral vessels (femoral
artery and femoral vein). These two layers again fuse into one at the medial border of the pectineus. Moreover,
fascia lata forms separate sheaths for tensor of fascia lata, sartorius and gracilis muscles.
From fascia lata to the femur there run two intermuscular septums of thigh, medial and lateral (septum
intermusculare femoris laterale et mediale), which adhere to the medial and lateral lips of linea aspera.
On the lateral surface of the thigh, the fascia is strengthened by tendons of tensor of fascia lata and
gluteus maximus; its fibers run vertically and it is called here iliotibial tract.
Deep fascia of leg (fascia cruris) is the continuation of the fascia lata, adheres to the medial condyle of
the tibia, patella and the head fibula. The fascia envelopes all the muscles of the leg, adheres to the medial
surface of the tibia and forms the anterior and posterior intermuscular septums (septum intermusculare cruris
anterius et septum intermusculare cruris posterius).
Above the medial malleoulus and lateral malleolus bones and anteriorly between the bones of leg, deep
fascia of leg has a transverse direction of fibers and between the two bones of the leg forms the superior
extensor retinaculum (retinaculum musculorum extensorum superius).
Below it there lies inferior extensor retinaculum (retinaculum musculorum extensorum inferius). It
origins on the lateral surface of the calcaneus and divides into two crura, oneof which is inserted on the medial
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malleolus of the tibia and the second - on the navicular and internal cuneiform bones (Fig. 40, 41).
Behind the medial malleolus there lies flexor retinaculum (retinaculum musculorum flexorum), which
runs from the medial malleolus of the tibia to the medial surface of the calcaneus.
Behind the lateral malleolus the fascia thickens, forming the superior and inferior peroneal retinaculum
(retinaculum musculorum fibularium superius et inferius).
The superior peroneal retinaculum runs from the lateral malleolus of the fibula to the lateral surface of
the calcaneus.
The inferior peroneal retinaculum is fixed on the lateral surface of the calcaneus.
On the dorsum of the foot there is the dorsal fascia of the foot (fascia dorsalis pedis). It covers the
tendons of muscles extensors of the leg, extensor hallucis brevis, extensor dgitorum brevis (of II-V toes),
vessels and nerves of the dorsum of the foot and also dorsal interossei.
On the dorsal surface of the foot there is plantar aponeurosis (aponeurosis plantaris). It is fixed on the
calcaneal tuberosity and covers the flexor digitorum brevis, with which it fuses. In its distal part the plantar
aponeurosis divides into five bundles, fuse with the walls of fibrous sheaths of toes. Bundles of fibers derive
vertically from the plantar aponeurosis. Moreover, from the plantar aponeurosis to the skin of the sole run the
vertical bundles of fibers, which fix the skin, fusing with it.
Laterally and medially, the plantar aponeurosis gets thinner, covering the muscles of the great toe and
muscles of the little toe.
The femoral canal (canalis femoralis) is formed only when there is a femoral hernia, normally it is
absent, it is a weak place in the abdominal wall.
The femoral canal is located inferiorly to the inguinal ligament, it has three walls.
Walls of the femoral canal: anterior – superficial layer of the fascia lata; posterior wall – deep layer
of fascia lata, which covers pectineus muscle and is called pectineal fascia (fascia pectinea); lateral wall –
femoral vein.
Openings of the femoral canal: saphenous opening and femoral ring.
Saphenous opening (hiatus saphenus), is a loosened thin part of the superficial layer of the fascia lata,
covered with fibers, which is called cribriform fascia (fascia cribrosa). It has openings for blood vessels and
nerves. Saphenous opening is bordered by the densed border of fascia lata, which is called falciform margin
(margo falciformis). In this margin, there distinguish superior horn (cornu superius), which adheres to the
inguinal ligament, and inferior horn (cornu inferius). Falciform margin is well marked externally and
inferiorly. Greater saphenous vein runs through the saphenous opening.
Femoral ring (аnulus femoralis) is the medial part of the vascular space. It is bordered:
superioanteriorly by the inguinal ligament, inferioposteriorly by the thickened periosteum of the pubic bone,
which is called pectineal ligament; externally by the femoral vein; medially by the lacunar ligament. Lacunar
ligament origins from the external crus of the inguinal ligament and runs to the pectineal line.
In the femoral ring there is one of the largest superficial inguinal lymph nodes. The femoral ring is
closed from the abdominal cavity by the transverse fascia, which in this area is loosened and is called the
femoral septum (septum femorale).
Femoral septum adheres to the pubic bone, so when the femoral hernia is formed, the intestine moves
the bundles of the femoral septum aside, so that it is not involved in the formation of the hernia sac.
SYNOVIAL SHEATHS OF THE FOOT
Under the inferior extensor retinoculum, as a result of the presence of membranes, which run from its
internal surface to the tarsal bones, there are formed four osteofibrous canals. Three of them contain synovial
sheaths (vagine synoviales digitorum pedis): medially - tendinous sheath of the tibialis anterior (vagina
tendinis musculi tibialis anterioris); in the middle - tendinous sheath of the extensor hallucis longus (vagina
tendinis extensoris hallucis longi musсuli); externally - tendinous sheath of the extensor digitorum longus
(vagina tendinum musculi extensoris digitorum longi). In the fourth fibrous canal there are: dorsal artery of
foot, two dorsal veins of foot and deep fibular nerve.
Under the flexor retinaculum, posteriorly to the medial malleolus bone, there also lie four fibrous
canals. In three of them there run independent synovial sheaths (front to back): the tendinous sheath of
tibialis posterior (vagina tendinis musculi tibialis posterioris); the tendinous sheath of flexor digitorum
longus (vagina tendinum musculi flexoris digitorum longi); the tendinous sheath of the flexor hallucis
longus (vagina tendinis musculi flexoris hallucis longi). The fourth fibrous canal contains the posterior tibial
artery, two posterior tibial veins, tibial nerve. The fibrous canal for vessels and nerves is located in the groove
between the osteofibrous canals of the tendons of the flexor digitorum longus and flexor hallucis longus.
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 Under the superior peroneal retinaculum, posteriorly of the lateral malleolus, in an individual
osteofibrous canal, there lies the common tendinous sheath of peronei (vagina communis tendinum
musсulorum fibularium). Under inferior peroneal retinaculum this sheath splits in two.
On the dorsal surface of foot there is plantar tendinous sheath of fibularis longus (vagina plantaris
tendinis musсuli fibularis longi), it runs obliquely from the lateral border of the foot to the medial one.
Tendinous sheaths of toes (vaginae tendinis digitorum pedis) are located in the osteofibrous canals of
the toes (vaginae fibrosae digitorum pedis).
Osteofibrous canals of the plantar surface of the toes are formed by phalanges, connective tissue fibers,
which, as well as on the hand, on the hand, are differentiated into anular (pars anularis vaginae fibrosae) and
cruciform (pars cruсіformis vaginae fibrosae) parts of fibrous sheath.
The synovial sheath of the great toe contains the tendon of the flexor hallucis longus and extends from
the base of the first metatarsal bone to the base of the distal phalanx of the great toe.
Synovial sheaths of II-V toes each contain two tendons –the tendon of the flexor digitorum longus and
the tendon of the flexor digitorum brevis. Synovial sheaths of II-V of toes extend from the level of the heads
of metatarsals to the bases of distal phalanges.

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