Professional Documents
Culture Documents
Muscle Origin Insertion Innervation Actions: Shoulder
Muscle Origin Insertion Innervation Actions: Shoulder
Superficial back
Pectoral region/axilla
Anterior forearm
Posterior forearm
Hand
Gluteal region
Posterior Thigh
Medial Thigh
Posterior Leg
Muscle Origin Insertion Innervation Actions
Gastrocnemius (S) Lat.H: lateral surface of the femoral condyle Tendo calcaneus (achilles tendon) which is inserted into a Tibial nerve (S1 & S2) Plantarflex the foot and assists in flexion of the knee
Med.H: posterior part of the medial condyle smooth transverse area on the middle third of the posterior joint and raises the heel during walking
and the popliteal surface of the shaft of the surface of the calcaneus
femur
Soleus (S) Proximal 1/4 of the back of the fibula Tendo calcaneus (achilles tendon) which is inserted into a Tibial nerve (S1 & S2) Plantarflex the foot and stabilizes the leg over the
including the head of the bone, soleal line of smooth transverse area on the middle third of the posterior foot when standing
the tibia and the middle 1/3 of the posterior surface of the calcaneus
border of the tibia
Plantaris (S) Distal part of the lateral supracondylar line of Tendo calcaneus (achilles tendon) which is inserted into a Tibial nerve (S1 & S2) Weakly assists Gastrocnemius
the femur smooth transverse area on the middle third of the posterior
surface of the calcaneus
Popliteus (D) Triangular area on the posterior surface of the Attached to a pit at the anterior end of a groove on the lateral Tibial nerve (L4, L5, & S1) Laterally rotates the femur to unlock the joint, in the
tibia above the soleal line surface of the lateral condyle of the femur seat position, it mediall rotates the tibia at the
commencement of flexion, and is a weak flexor of
the knee (possibly retracts the lateral meniscus)
Flexor Hallucis Flexor surface (posterior) of the fibula and the Base of the distal phalanx of the big toe Tibial nerve (S1 & S2) Flex the big toe, plantarflex the foot at the ankle
Longus (D) adjacent interosseous membrane joint, and the pull of this muscle is an important
factor in maintaining the medial longitudinal arch
Tibialis Posterior Posterior tibia below the soleal line, Tuberosity of the navicular bone, all the cuneiforms, cuboid, and Tibial nerve (L4) Inverts and adducts the forefoot, plantarflexes the
(D) interosseous membrane, and proximal half of bases of the 2nd, 3rd, & 4th metatarsals ankle joint, and contributes to maintaining the
the posterior fibula medial longitudinal arch of the foot
Flexor Digitorum Posterior surface of the tibia below the soleal Pass into the fibrous sheaths of the lateral four toes, perforate the Tibial nerve (S1 & S2) Flex the lateral four toes, plantarflex the foot at the
Longus (D) line tendons of flexor digitorum brevis and inserts into the bases of ankle joint, and assists with maintaining the
the distal phalanges (medial two tendons receive a strong slip longitudinal arch of the foot
from flexor hallucis longus)
Anterior Leg
Lateral Leg
1. Type: Typical synovial ball and socket joint with three degrees of freedom
2. Articulation: Concave acetabulum of the hip bone (os coxae), with its C-shaped articular (lunate) suface covered by hyaline cartillage, the
spherical head of the femur, acetabular labrum (made of fibrocartilage)
a. The fovea, the acetabular fossa, and the acetabular notch are non-articular surfaces
3. Capsular attachments: Attached proximally to the margin of the acetabulum outside the labrum,, the free edge of the labrum and the
transverse acetabular ligament; distally attached to the neck of the femur, anteriorly, to the intertrochanteric line, and posteriorly, 2 cm
proximal to the intertrochanteric crest; retinacular fibers are reflected from these attachments on the neck of the femur and proximally along
the neck to the articular margin of the femoral head, eventually blending in with the periosteum of the bone
4. Intracapsular structure: Acetabular labrum, transverse acetabular ligament, and fat pads in the acetabular fossa
5. Intrinsic ligaments: Iliofemoral (inverted “V” – very strong), pubofemoral (not as strong as iliofemoral), and ischofemoral (weakest) and
Ligamentum teres (not strong – this along with the haversin fat pads are invested with a sleeve of synovium as far as the acetabular fossa);
Extrinsic ligaments: None
6. Movements: Flexion (iliopsoas and assisted by rectus femoris), extension (superior fibers of gluteus maximus and hamstrings), abduction
(gluteus maximus upper fibers, tensor fascia latae, and assisted by piriformis, gluteus medius, and gluteus minimus), adduction (adductors,
pectineus, and gracilis), medial rotation (anterior fibers of gluteus medius and minimus, and assisted by tensor fascia latae), and lateral
rotation (inferior fibers of gluteus maximus and quadratus femoris, and assisted by obturator internus and externus, superior and inferior
gemelli, piriformis, and sartorius)
7. Stability: Stable joint due to the deep acetabular cup and well-fitting femoral head (fitting is enhanced by the acetabular labrum); the strong
ligaments (iliofemoral, pubofemoral, and ischiofemoral) and muscles surrounding the joint increases the stability
8. Relations: Anterior (iliopsoas and pectineus), posterior (piriformis, gemelli, obturator internus, quadratus femoris, and sciatic nerve),
superficial (gluteal muscles posteriorly and tensor fascia latae anteriorly), and inferiorly (obturator externus)
9. Blood supply: medial and lateral circumflex humeral arteries off of the profunda femoris artery (they may give off retinacular arteries
directly from the ascending branches or supply them through two anastomoses – trochanteric [ascending branches of medial and lateral
circumflex femoral arteries, and cruciate; the lateral epiphyseal arteries off of the retinacular arteries are the most important blood suppliers to
the femoral head); Nerve supply: Femoral nerve via the rectus femoris, obturator nerve, nerve to quadratus femoris, and articular twigs from
the sciatic nerve
10. Bursae: Trochanteric bursa (between gluteus maximus and the greater trochanter), iliopsoas bursa (between the ilipsoas and the iliopubic
ramus/head of the femur
11. Clinical: Fracture of the neck of the femur, avascular necrosis of the femoral head, congenital dislocation of the hip, traumatic dislocation
with sciatic nerve damage (posterior dislocation), slipped epiphysis (fracture through the growth plate), Perthes disease (avascular necrosis of
the head of the femur due to blood flow disruption at a young age causing improper growth of the femoral head – necrosed bone is replaced
but never fully recovers to the fully size as would have with complete blood flow)
Knee Joint
1. Type: Typical synovial pivotal hinge joint (mobile trocho-ginglymus) or typical synovial condyloid joint, with two degrees of freedom
a. Each femoral condyle has two curvatures – anterposterior and mediolateral
b. 6○ of freedom clinically: valgus/varus, flexion/extension, internal/external rotation, anterior/posterior translation, medial/lateral
translation, and compression/distraction
2. Articulation: Femoral condyles (fused anteriorly by trochlear notch and posteriorly by the intercondylar notch/fossa), two articular facet on
the upper surface of the tibia, and two C-shaped fibrocartilaginous menisci in between the articulating facet and the condyles
3. Capsular attachment: Posteriorly (proximal margins of the femoral condyles, intercondylar fossa, and distal margins of the tibial condyles),
medially (articular margins), laterally (proximal to attachment of popliteus), and anteriorly (capsule is deficient above the patella [thus there is
a suprapatellar bursa,which is superficial to the lower part of the femur and deep to the rectus femoris tendon], blends in with the retinacular
fibres of the vasti, attaches to the patella and the patellar ligament)
4. Intracapsular structures: Anterior cruciate ligament (prevents hyper extension of the knee – goes from the anterior intercondylar area
upwards, backwards, and laterally to the medial aspect of the lateral condyle), posterior cruciate ligament (prevents the femur slipping off the
fixed tibia – goes from the posterior intercondylar area upwards, forwards, and medially to the lateral aspect of the medial condyle), menisci
(the medial 1/2 of the popliteus fibres are attached to the posterior convexity of the lateral meniscus; the deep fibres of the tibial (lateral)
collateral ligament are attached to the lateral convexity of the medial meniscus), popliteus tendon, suprapatellar bursae, and superficial and
deep infrapatellar bursae
5. Intrinsic ligaments: Anterior and posterior cruciate ligaments (both are extrasynovial) , transverse ligament (attaches the anterior edges of
the menisci), and posterior meniscofemoral ligament (attaches the posterior lateral meniscus to the medial condyle of the femur); Extrinsic
ligaments: Patellar ligament (attaches the patella to the tibial tuberosity), medial and lateral collateral ligament (both prevent valgus and
varus movements), arcuate popliteal (fibular head to the knee joint capsule), and oblique popliteal (lateral femur to the posterior tibia)
6. Movements: Flexion (hamstrings – 120○ when hip is extended, 140○ when hip is flexed, and 160○ when sitting on heels), extension
(quadriceps muscle – 5-10○ beyond straight, limited by collateral ligaments, iliotibial band, cruciate ligaments, posterior capsule, and oblique
popliteal ligamaent), medial and lateral rotation may be active (60-70○ ) or passive (only occurs at the end of extension for 20○ – done by
popliteus) both of which is caused by the hamstrings acting on the fixed tibia
a. Rotation takes place between the menisci and the tibia while flexion and extension occur between the menisci and the femur
7. Stability: Most unstable joint of the lower limb since there is a low degree of bone articulation between the femur and the tibia; ligaments and
muscles are the main contributors to stability
8. Relations: Anteriorly (quadriceps tendon, patella, and patellar ligament), posteriorly (popliteal fossa and its contents), medially (sartorius and
gracilis), and laterally (iliotibial band)
9. Blood supply: Genicular anastomosis; Nerve supply: Tibial, common peroneal, femoral, and obturator nerves
10. Bursae: 15 in total around the knee (main ones – suprapatellar, anserine, prepatellar, subcutaneous infrapatellar, and deep infrapatellar)
11. Clinical: Baker’s cyst (posterior herniation of the synovial membrane), patellar reflex (L2-4), knee replacement (total knee arthroscopy) etc.
Ankle Joint (Talocrural joint)
1. Type: Typical modified synovial hinge joint (mortise joint) with one degree of freedom
2. Articulation: Inferior facet of the tibia (weight bearing), trochlea of the talus (weight bearing), medial facet of the talus (not weight bearing),
lateral facet of the talus (not weight bearing), facet on the lateral malleolus of the fibula (not weight bearing), and facet on the medial
malleolus of the tibia (not weight bearing)
3. Capsular attachment: Attached to the articular margins of the tibia, fibula, and talus; anteriorly it extends to the neck of the talus and
posteriorly it is attached to the posterior tibiofibular ligament; the capsule is thinner anteriorly and posteriorly in the direction of movement
4. Intracapsular structure: None
5. Intrinsic ligaments: None; Extrinsic ligaments: Lateral collateral ligament (broken into three parts since the lateral malleoulus is more
mobile than the medial malleolus – anterior talofibular ligament [anterior border of the lateral malleolus to the neck of the talus],
calcaneofibular ligament [medial side of the lateral malleolus to a groove on the lateral surface of the calcaneus – houses most of the
proprioceptors], and posterior talofibular ligament [malleolar fossa to the posterior tubercle of the talus]), anterior and posterior tibiofibular
ligaments, and deltoid/medial collateral ligament (anterior tibiotalar ligament [medial malleolus to the medial aspect of the neck of the talus],
posterior tibiotalar ligament [medial malleolus to the posterior tubercle of the talus], tibionavicular ligament [medial malleolus to the
tuberosity of the navicular], and tibiocalcaneal ligament [medial malleolus to the sustenticulum tali])
6. Movements: Plantarflexion (60○ – most powerfully produced by soleus and gastrocnemius) and dorsiflexion (15-20○ – produced by tibialis
anterior, peroneus tertius, extensor halicus longus, and extensor digitorum longus)
7. Stability: Stable joint and the most important factor contributing to its stability is the integrity of the inferior tibiofibular joint (syndesmosis)
whose interosseous fibres hold the malleoli together; collateral ligaments further stabilises the joint
a. Greater bony congruence when the foot in dorsiflexed thus the joint is more stabilised in that position
8. Relations: Anterior (extensor muscles, peroneus tertius, tibialis anterior, anterior tibial artery and vein, and deep peroneal nerve), posterior
(flexor muscles, posterior tibial artery, tibialis posterior, tibial nerve, and tendo calcaneus), medial (deltoid ligament), and lateral (lateral
collateral ligament)
9. Blood supply: Anterior and posterior tibial arteries and to some extent by the peroneal artery; Nerve supply: Tibial and deep peroneal nerve
10. Bursae: None that we need to know
11. Clinical: Avulsion fracture of the lateral malleolus, anterior talofibular and posterior talofibular ligament tears, avascular necrosis of the
lateral process of the talus etc.
Talocalcaneonavicular joint
Talocalcanean joint
● Type: Posteriorly it is modified multiaxial joint (Grays) or a hinge/uniaxial joint (Rodgers); Anteriorly it is a plane synovial joint with one
degree of freedom
Axilla
● Borders
o Apex: Bounded by 1st rib, clavicle, and superior border of the scapula
o Base: Skin of armpit and axillary fascia from arm to thoracic wall
o Anterior: Pectoralis major and minor
o Posterior: Subscapularis, teres major, and latissimus dorsi
o Medial: 1st through 4th ribs, serratus anterior, and intercostal muscles
o Lateral: Intertubercular groove of the humerus
● Contents: Axillary artery (and branches), axillary vein (and tributaries), axillary lymph nodes (apical, pectoral, subscapular, humeral, and
central), and brachial plexus
Quadrangular Space
● Borders
o Superior: Teres minor
o Inferior: Teres major
o Medial: Long head of triceps
o Lateral: Surgical neck of humerus
● Contents: Axillary nerve and posterior circumflex humeral artery
● Borders
o Superior: Teres major
o Medial: Long head of triceps
o Lateral: Shaft of humerus
● Contents: Radial nerve and profunda barchii artery
Triangular Space (Medial Triangular Space)
● Borders
o Superior: Teres minor and subscapularis
o Inferior: Teres major
o Lateral: Long head of triceps
● Contents: Scapular circumflex artery
● Borders
o Superior (proximal): Imaginary line connecting the medial and lateral condyles
o Medial: Pronator teres
o Lateral: Brachoradialis
o Floor (deep): Brachialis, supinator, and median cubital vein
o Superficial (roof): Deep fascia, bicipital aponeurosis, subcutaneous tissue, and skin
● Contents: Superficial and deep branches of the radial nerve, biceps brachii tendon, brachial artery (and its terminal branches), and median
nerve (lateral to medial NTAN)
Anatomical Snuffbox
● Borders:
o Medial: Extensor pollicis longus
o Lateral: Extensor pollicis brevis and abductor policis longus
o Superficial (roof): Cutaneous branches of the radial nerve
o Deep (floor):Extensor carpi radialis longus and radial artery
● Contents: Cephalic vein; radial styloid process, scaphoid, trapezium, and the base of the first metacarpal is palpable in the snuffbox
Carpal Tunnel
● Transverse carpal ligament connecting the hamate & pisiform to the scaphoid & trapezium
● Contents: Flexor digitorum superficialis (4 tendons), Flexor digitorum profundus (4 tendons), flexor pollicis longus, and median nerve
Femoral Triangle
● Borders
o Superior (proximal): Inguinal ligament
o Medial: Medial border of adductor longus
o Lateral: Medial border of Sartorius
o Superficial (roof): fascia lata/cribiform fascia
o Deep (floor): adductor longus and pectineus
● Contents: Popliteal artery and vein, tibial and common peroneal nerves, and a small group of popliteal lymph nodes
Popliteal Fossa
● Borders
o Superolateral: Biceps femoris
o Superomedial: Semitendinosus and semimembranosus
o Inferolateral: Lateral head of gastrocnemius
o Inferomedial: Medial head of gastrocnemius and plantaris
o Superficial (roof): Fascia lata pierced by the lesser (small) saphenous vein
o Deep (floor):Popliteal surface of the femur, knee joint capsule, and popliteus muscle
● Contents: Popliteal artery and vein, tibial and common peroneal nerves, and a small group of popliteal lymph nodes
Types of Joints – Less relevant joints
Superficial veins
● Cephalic vein starts in the in the anatomical snuff box and goes up the lateral part of the arm and forearm via the deltopectoral groove and
pierces the clavipectoral fasci and inserts into the axial vein
o Communicates with the brachial vein via the median cubital vein at the median cubital fossa
● Basilic vein originates from the medial side of the dorsal venous network of the hand and travel up the medial part of the arm and forearm and
pierces the brachial fascia above the medial epicondyle to enter into the brachial vein
Deep Artery
● Subclavian artery turns into the axillary artery at the lateral margin of the first rib
o Branches off the axillary artery
▪ 1st part (artery medial to pectoralis minor): Superior Thoraccic
▪ 2nd part (posterior to pectoralis minor): Thoracoacromical and Lateral Thoraccic
▪ 3rd part (lateral to pectoralis minor): Subscapular (gives off circumflex scapular which goes through the triangular space),
Anterior Circumflex Humeral, and Posterior Circumflex Humeral (goes through the quadrilateral space)
● Axillary artery turns into the brachial artery at the lower margin of the teres major
o Almost immediately the brachial artery gives off the profunda brachii branch which goes through the triangular interval and travels
along the radial groove to meet with the radial artery after the brachial artery splits
● The brachial artery splits into the radial and the ulnar arteries (halfway down the median cubital fossa) which travel down the lateral and
medial aspects of the forearm respectively
o The ulnar artery gives off the common interosseous artery which splits into the anterior and posterior interosseous arteries
o The ulnar artery primarily supplies the superficial palmar arch
▪ Primary blood supply to the lateral side of the 2nd digit, and the 3rd, 4th, and 5th digits completely
o The radial artery primarily supplies the deep palmar arch
▪ Primary blood supply to the medial side of the 2nd digit and the 1st digit (thumb) completely
Upper Limb Nerve injuries
● Erb’s Palsy (C5 and C6 root injury): waiter’s tip (arm hanging by the side, extended at the elbow, medially rotated, and pronated
● Klumpke’s Paralysis (C8 and T1 root injury): ulnar claw hand (inability to extend fingers and sensory loss on the ulnar side of the forearm)
● Axillary nerve damage (dislocations of the shoulder (5%) or fractures of the neck of the humerus): shoulder abduction is weak
o Complete division of the axillary nerve is unlikely
● Radial nerve damage (mid shaft humeral fracture around the radial groove region): can still extend the elbow but causes wrist drop (unable to
extend the wrist and metacarpophalageal joints)
o Radial nerve is more likely to be damaged high up (in brachial region instead of the elbow and further down)
● Ulnar nerve damage (most commonly damaged at the elbow or at the wrist): claw hand (hyperextension of the meracarpophalangeal joints,
flexion of the interphalangeal joints due to interossei and lateral two lumbricals being paralysed)
o Injury at the elbow or above gives straighter fingers because the medial half of the flexor digitorum profundus is also paralysed
● Median Nerve (most commonly injured at the wrist): wasting of the abductor pollicis brevis (primary sign)
Major Blood Vessel Branches – Lower Limb
Superficial veins
● Greater Saphenous vein starts at the medial aspect of the dorsum of the foot and courses upwards anterior to the medial malleolus along the
medial side of the leg, moving posteriorly around the medial condyle of the femur and up the medial aspect of the thigh, piercing the
cribiform fascia (3 cm below and lateral to the pubic tubercle) to join the femoral vein
o Incompetence valves in the vein can be the cause of varicosity
● Lesser Saphenous vein originates from the lateral side of the dorsum of the foot and travels up posterior to the lateral malleolus up the medial
part of the leg and pierces the popliteal fascia to enter into the popliteal vein
Deep Artery
● External iliac artery turns into the femoral artery once it crosses the inguinal canal midway between the anterior superior iliac spine and the
pubic symphysis
o Branches off the femoral artery
▪ 4 small branches immediately: superficial circumflex iliac, superficial epigastric, superficial external pudendal, and deep
external pudendal
▪ Profunda femoris branch is given off just after the termination of the femoral sheath
● The profunda femoris gives rise the medial (gives off an ascending, transverse and a descending branch) and lateral
circumflex femoral arteries
▪ The descending genicular artery is given off just prior to the femoral artery going through the adductor hiatus
▪ There is a risk of aneurysm occurrence in the femoral artery after the profunda femoris branching and prior to the descending
genicular artery origination
● After passing through the adductor hiatus the artery is known as the popliteal artery
o Popliteal artery branches
▪ Anastamotic branches: superior medial genicular, inferor medial genicular, superior lateral genicular, inferior lateral genicular,
middle genicular
▪ There is a risk of aneurysm occurrence in the popliteal artery
● The popliteal artery splits into the anterior tibial (goes to the anterior aspect through the oval opening at the proximal aspect of the
interosseous membrane) and the posterior tibial arteries (this provides another branch, peroneal artery which runs along the back of the fibula)
o The posterior tibial continues on to separate into the medial plantar (mainly supplies the big toe) and the lateral plantar (supplies the
plantar arch and connects to the dorsaelis pedis (via the connecting deep plantar artery) artery by passing through the first cleft
o The anterior tibial artery becomes the dorsaelis pedis artery once it crosses the imaginary line connecting the tow malleoli