CAPP 551 Lower limb origins, insertions, innervations and actions

MUSCLES OF THE GLUTEAL REGION

GLUTEUS MAXIMUS

ORIGIN - Posterior of iliac crest - Posterior surface of sacrum and coccyx near the ilium - Fascia of the lumbar area - Lateral surface of ilium just below iliac crest and between the anterior and posterior gluteal lines

INSERTION - Gluteal tuberosity of femur - ITB

NERVE SUPPLY Inferior Gluteal L5 S1 S2

ACTION - Hip extension - Hip external rotation - Upper fibres assist in abduction - Lower fibres assist in adduction - Posterior pelvic tilt - Hip abduction - Anterior fibres: hip internal rotation and hip flexion - Posterior fibres: hip external rotation and hip extension See lecture and lab notes regarding gluteal function

GLUTEUS MEDIUS

- Posterior and middle surfaces of the greater trochanter

Superior Gluteal Nerve L5 S1

GLUTEUS MINIMUS

- Lateral surface of the ilium (below origin of glut medius)

- Anterior surface of the greater trochanter

Superior Gluteal Nerve L4 L5 S1

- Hip abduction - Medial rotation hip as femur abducts - Hip flexion See lecture and lab notes regarding gluteal function

TENSOR FASCIA LATA

- Anterior part of the iliac crest and lateral surface of the ilium

- As the iliotibial tract on Gerdys tubercle of the antero-lateral tibial condyle - Posterior aspect of greater trochanter

Superior Gluteal Nerve L4 L5

- Hip abduction - Hip flexion - Hip internal rotation with hip flexion - Anterior pelvic tilt - Hip external rotation

PIRIFORMIS GEMELLUS SUPERIOR GEMELLUS INFERIOR OBTURATOR EXTERNUS OBTURATOR INTERNUS QUADRATUS FEMORIS

- Sacrum - Posterior portions of ischium - Obturator foramen and membrane for OE (external surface) and OI (internal surface)

- Nerve to - OE: Obturator nerve

MUSCLES OF THE ANTERIOR HIP & THIGH

SARTORIUS

ORIGIN

INSERTION

NERVE SUPPLY

ACTION

- ASIS - Lesser sciatic notch

- As pes anserinus on anterior medial tibial condyle

Femoral Nerve L2 L3

RECTUS FEMORIS

- Straight head: AIIS - Reflected head: ilium superior to acetabulum + capsule - Intertrochanteric line - Anterior and inferior borders of greater trochanter - Upper of linea aspera - Lateral intermuscular septum - Linea aspera - Medial condylar ridge

VASTUS LATERALIS

- Superior border of patella - By patella tendon to tibial tuberosity - Lateral border of patella - By patella tendon to tibial tuberosity - Medial border of patella - By patella tendon to tibial tuberosity - Superior border of patella - By patella tendon to tibial tuberosity

Femoral nerve L2 L3 L4

- Hip flexion - Knee flexion - Ext rotation of hip with hip and knee flexion - Hip abduction - Anterior pelvic tilt - Hip flexion - Knee extension - Anterior pelvic rotation - Knee extension

Femoral nerve L2 L3 L4

VASTUS MEDIALIS

Femoral nerve L2 L3 L4

- Knee extension

VASTUS INTERMEDIUS

- Upper 2/3 of anterior surface of femur

Femoral nerve L2 L3 L4

- Knee extension

MUSCLES OF THE POSTERIOR THIGH

BICEPS FEMORIS

ORIGIN Long head: - Ischial tuberosity Short head: - Lower half of linea aspera laterally - Lateral condyloid ridge of femur - Ischial tuberosity

INSERTION - Lateral condyle of tibia - Head of fibula

NERVE SUPPLY Long head: - Tibial division of sciatic nerve L5 S1 S2 Short head: - Common fibular division of sciatic n. L5 S1 S2

ACTION - Knee flexion - Hip extension - Hip external rotation - External rotation of flexed knee - Posterior pelvic tilt

SEMITENDINOSUS

- As pes anserinus on upper anterior medial surface of tibia

Tibial division of sciatic nerve L5 S1 S2

- Knee flexion - Hip extension - Hip internal rotation - Internal rotation of flexed knee - Posterior pelvic tilt - Knee flexion - Hip extension - Hip internal rotation - Internal rotation of flexed knee - Posterior pelvic tilt - Knee flexion - Internal rotation of flexed knee F: Unlocks knee CKC: Rotates femur laterally OKC: Rotates tibia medially

- Ischial tuberosity SEMIMEMBRANOSUS

- Postero-medial surface of medial tibial condyle

Tibial division of sciatic nerve L5 S1 S2

POPLITEUS

- Upper posterior medial surface of tibia

- Posterior surface of lateral femoral condyle

Tibial nerve L4 L5 S1

Recall that the hamstring portion of adductor magnus could be included in this group.

MUSCLES OF THE MEDIAL THIGH

GRACILIS

ORIGIN - Anterior medial edge of inferior pubic ramus

INSERTION - As pes anserinus on anterior medial surface tibia (below medial condyle) - Middle 1/3 linea aspera

NERVE SUPPLY Obturator nerve L2 L3

ACTION - Hip adduction - Weak knee flexor - Hip internal rotation hip - Assists with hip flexion - Hip adduction - Assists in hip flexion F: Hip stabilizer- assist in posture and is synergist in complex gait patterns - Hip adduction - Hip ext rotation with hip adduction - Assists with hip flexion F: Hip stabilizer- assist in posture and is synergist in complex gait patterns - Hip adduction - External rotation as hip adducts - Hip extension F: Hip stabilizer- assist in posture and is synergist in complex gait patterns - Hip flexion - Hip adduction - Rotation role unclear may depend upon hip joint position

ADDUCTOR LONGUS

- Anterior pubis just below crest

Obturator nerve L2 L3 L4

ADDUCTOR BREVIS

- Inferior pubic ramus (below adductor longus origin)

- Lower 2/3 of pectineal line - Upper half of medial lip of linea aspera

Obturator nerve L2 L3 L4

ADDUCTOR MAGNUS

Hamstring portion: -Ischial tuberosity Adductor portion: - Ischial ramus - Some inferior ramus pubis - Superior pubic ramus

-Linea aspera - Inner condyloid ridge - Adductor tubercle of femur

Adductor portion: - Obturator Nerve L2 L3 L4 Hamstring portion - Tibial div. of Sciatic Nerve

- Pectineal Line of Femur

PECTINEUS

Femoral Nerve L2 L3 L4 (+ accessory obturator if presentL3)

MUSCLES OF THE ILIAC REGION

PSOAS MAJOR

ORIGIN - Lower borders transverse processes of L1-L5 - Sides of bodies of T12-L5 and corresponding intervertebral discs - Base of sacrum - Inner surface of ilium

INSERTION - Lesser trochanter

NERVE SUPPLY Ventral rami of spinal nerves L1, L2, L3

ACTION -Flexion hip -Hip external rotation

ILIACUS

Lesser trochanter

Femoral Nerve L2 L3

-Flexion hip - Hip external rotation

See lecture and lab notes regarding iliac group function

MUSCLES OF THE POSTERIOR LEG (SUPERFICIAL)

GASTROCNEMIUS

ORIGIN

INSERTION

NERVE SUPPLY

ACTION

MEDIAL HEAD -Posterior surface of medial femoral condyle LATERAL HEAD - Posterior surface of lateral femoral condyle

- Posterior surface of calcaneus (via Achilles tendon)

Tibial nerve S1 S2

- Ankle plantarflexion (in knee ext) - Knee flexion

SOLEUS

-Posterior surface of head and shaft of fibula -Soleal line of tibia - Medial border of tibia

Calcaneus (via Achilles tendon)

Tibial nerve S1 S2

- Ankle plantarflexion - Weak subtalar joint inversion F: Stabilises leg on foot to adjust postural sway

MUSCLES OF THE POSTERIOR LEG (DEEP)

TIBIALIS POSTERIOR (Tom)

ORIGIN

INSERTION

NERVE SUPPLY

ACTION

- Posterior tibia - Posterior surface fibula - IOM - Middle 1/3 posterior surface tibia

FLEXOR DIGITORUM LONGUS (Dick)

Plantar surface of: -Navicular -Cuboid -Cuneiforms - Base metatarsals 2-4 -Plantar surface of bases distal phalanges digits 2-5

Tibial L4 L5

- Inversion subtalar/foot - Weak ankle plantarflexor F: Supports medial longitudinal arch and transverse arch of foot -Flexion of MTPJs and IPJs of toes 2-5 -Inversion subtalar joint - Ankle plantarflexion F: Supports longitudinal and transverse arches

Tibial L5 S1 S2

FLEXOR HALLUCIS LONGUS (Harry)

-Distal 2/3 posterior surface fibula -IOM

Plantar surface of base of distal phalanx of hallux

Tibial L5 S1 S2

-Flexes great toe at 1st MTPJ & IPJ - Weak Inverter of subtalar joint - Weak ankle plantarflexor F: Exerts powerful forces through big toes during push off in gait

MUSCLES OF THE ANTERIOR LEG

TIBIALIS ANTERIOR

ORIGIN

INSERTION

NERVE SUPPLY

ACTION

-Lateral tibial condyle -Proximal 2/3 of lateral surface of tibia -IOM -Middle of medial surface fibula -IOM -Lateral tibial condyle -Proximal 2/3 anterior surface of fibula -IOM Distal 1/3 anterior surface of fibula -IOM

-Medial cuneiform -Base 1st metatarsal

Deep Fibular Nerve L4 L5

- Ankle dorsiflexion - Subtalar inversion F: Maintains MLA -Adjustment posture

EXTENSOR HALLUCIS LONGUS

Dorsal base distal phalanx of hallux

Deep Fibular Nerve L5

- Ankle dorsiflexion - Extension of great toe at MTPJ and IPJs - Weak subtalar inverter -Extends digits MTPJs and IPJs 2-5 - Ankle dorsiflexion - Subtalar eversion - Subtalar eversion - Ankle dorsiflexion F: Support lateral longitudinal arch

EXTENSOR DIGITORUM LONGUS

Dorsal surface of middle and distal phalanges digits 2-4 (dorsal digital expansion) Dorsal surface base 5th metatarsal

Deep Fibular Nerve L5 S1

FIBULARIS TERTIUS (often blended with EDL)

Deep Fibular Nerve L5 S1

MUSCLES OF THE LATERAL LEG

FIBULARIS LONGUS

ORIGIN -Head of fibula -Proximal 2/3 of lateral surface of fibula

INSERTION -Plantar Base 1st metatarsal -Medial cuneiform

NERVE SUPPLY Superficial Fibular L5 S1

ACTION - Eversion subtalar joint and foot - Ankle plantarflexion (weak) F: Supports medial and transverse arches

FIBULARIS BREVIS

- Distal 2/3 of lateral surface fibula

Tubercle on dorsal lateral base 5th metatarsal

Superficial Fibular L5 S1

-Eversion subtalar joint and foot - Ankle plantarflexion (weak)