Download - Class 6 Ap1 Muscles
Muscles of the Pelvis and Thigh
Review Week 5
Latissimus DorsiP: SPs of T7-L5, posterior
sacrum, and the posterior iliac crest
D: Medial lip of bicipital groove of the humerus
1. Medially rotates the arm at the shoulder joint
2. Adducts the arm at the shoulder joint
3. Extends the arm at the shoulder joint
4. Anteriorly tilts the pelvis at the lumbosacral joint
Rhomboid Major and Minor
• P: SPs of C7-T5• D: Medial border of
the scapula from the root of the spine of the scapula to the inferior angle of the scapula
1. Retracts (Adducts) the scapula at the scapulocostal joint
2. Elevates the scapula
Serratus Anterior
O: Ribs 1-9
I: Anterior surface of the entire medial border of the scapula
1. Protracts (abducts) the scapula at the scapulocostal joint
2. Upwardly rotates the scapula at the scapulocostal joint
Serratus Posterior Superior
• 1. Elevates ribs #2-5 at the sternocostal and costospinal joints
Serratus Posterior Inferior
• 1. Depresses ribs #9-12 at the sternocostal and costospinal joints
Erector Spinae Group
O: PelvisI: Spine, ribcage, and head
1. Extends the trunk, neck, and the head at the spinal joints
2. Laterally flexes the trunk, neck, and head at the spinal joints
3. Ipsilaterally rotates the trunk, neck, and head at the spinal joints
4. Anteriorly tilts the pelvis at the lumbosacral joint
Transversospinalis Group
O: PelvisI: Spine and the head
1. Extends the trunk, neck, and head at the spinal joints
2. Laterally flexes the trunk, neck, and head at the spinal joints
3. Contralaterally rotates the trunk and the neck at the spinal joints
4. Anteriorly tilts the pelvis at the lumboscaral joint
Quadratus Lumborum
P: 12th rib and the TPs of L1-L4
D: Posterior Iliac crest
1. Elevates the pelvis at the lumbosacral joint
2. Anteriorly tilts the pelvis at the lumbosacral joint
3. Laterally flexes the trunk at the spinal joints
4. Extends the trunk at the spinal joints
Pectoralis Major
• P: Medial clavicle, sternum, and the costal cartilages of ribs 1-7
• D: Lateral lip of the bicipital groove of the humerus
1. Adducts the arm at the shoulder joint
2. Medially rotates the arm at the shoulder joint
3. Flexes the arm at the shoulder joint (clavicular head)
Pectoralis Minor
P: Ribs 3-5
D: Coracoid process of the scapula
1. Protracts (abducts) the scapula at the scapulocostal joint
2. Depresses the scapula at the scapulocostal joint
3. Elevates ribs 3-5 at the sternocostal and costospinal joints
Diaphragm
• Increases the volume of the Thoracic Cavity (inspiration)
RectusAbdominis
P: Pubis
D: Xiphoid process and the cartilage of ribs 5-7
1.Flexes the trunk at the spinal joints
2.Posteriorly tilts the pelvis at the lumbosacral joint
External ObliqueP: Anterior iliac crest, pubic
bone, and the abdominal aponeurosis
D: Lower 8 ribs (5-12)
1. Flexes the trunk at the spinal joints
2. Laterally flexes the trunk at the spinal joints
3. Contralateral rotates the trunk at the spinal joints
4. Posteriorly tilts the pelvis at the lumbosacral joints
Internal ObliqueO: Inquinal ligament, iliac crest,
and the thoracolumbar fascia
I: Lower three ribs (10-12) and the abdominal aponeurosis
1. Flexes the trunk at the spinal joints
2. Laterally flexes the trunk at the spinal joints
3. Ipsilaterally rotates the trunk at the spinal joints
4. Posteriorly tilts the pelvis at the lumbosacral joints
Transverse Abdominis
• Compresses the abdominal contents
Psoas Major
P: Anterolateral lumbar spine
D: Lesser trochanter of the femur
1. Flexes the thigh at the hip joint
2. Laterally rotates the thigh at the hip joint
3. Flexes the trunk at the spinal joints
4. Laterally flexes the trunk at the spinal joints
5. Anteriorly tilts the pelvis at the hip joints
Iliacus
P: Internal Ilium
D: Lesser trochanter of the femur
1. Flexes the thigh at the hip joint
2. Laterally rotates the thigh at the hip joint
3. Anteriorly tilts the pelvis at the hip joints
Psoas Minor
1. Flexes the trunk at the spinal joints
2. Posteriorly tilts the pelvis at the lumbosacral joint
Gluteus Maximus
P: Posterior iliac crest, posterolateral sacrum, and the coccyx
D: Iliotibial band (ITB) and gluteal tuberosity of the femur
1. Extends the thigh at the hip joint
2. Laterally rotates the thigh at the hip joint
3. Abducts the thigh at the hip joint (upper 1/3)
4. Adducts the thigh at the hip joint (lower 2/3)
5. Posteriorly tilts the pelvis at the hip joint
Gluteus Medius
P: External Ilium
D: Greater trochanter of the femur
1. Abducts the thigh at the hip joint (entire muscle)
2. Flexes the thigh at the hip joint (anterior fibers)
3. Medially rotates the thigh at the hip joint (anterior fibers)
4. Extends the thigh at the hip joint (posterior fibers)
5. Laterally rotates the thigh at the hip joint (posterior fibers)
6. Posteriorly tilts the pelvis at the hip joint (posterior fibers)
7. Anteriorly tilts the pelvis at the hip joint (anterior fibers)
Gluteus Minimus
P: External Ilium
D: Greater trochanter of the femur
1. Abducts the thigh at the hip joint (entire muscle)
2. Flexes the thigh at the hip joint (anterior fibers)
3. Medially rotates the thigh at the hip joint (anterior fibers)
4. Extends the thigh at the hip joint (posterior fibers)
5. Laterally rotates the thigh at the hip joint (posterior fibers)
6. Posteriorly tilts the pelvis at the hip joint (posterior fibers)
7. Anteriorly tilts the pelvis at the hip joint (anterior fibers)
Deep Lateral Rotators of the Thigh
• Piriformis
• Superior Gemellus
• Obturator Internus
• Inferior Gemellus
• Obturator Externus
• Quadratus Femoris
Piriformis
P: Anterior sacrum
D: Greater trochanter of the femur
1. Laterally rotates the thigh at the hip joint
Tensor Fasciae Latae (TFL)
P: Anterior Superior Iliac Spine
D: Iliotibial band (ITB)
1. Flexes the thigh at the hip joint
2. Abducts the thigh at the hip joint
3. Medially rotates the thigh at the hip joint
4. Anteriorly tilts the pelvis at the hip joint
Sartorius
P: Anterior superior iliac spine (ASIS)
D: Pes Anserine Tendon (at the proximal anteromedial tibia)
1. Flexes the thigh at the hip joint
2. Abducts the thigh at the hip joint
3. Laterally rotates the thigh at the hip joint
4. Flexes the leg at the knee joint
5. Anteriorly tilts the pelvis at the hip joint
Pes Anserine
• The three muscles that attach here are from anterior to posterior:
1.Sartorius
2.Gracilis
3.Semitendinosus
Rectus Femoris
P: Anterior Inferior iliac spine (AIIS)
D: Tibial Tuberosity
1.Extends the leg at the knee joint
2.Flexes the thigh at the hip joint
3.Anteriorly tilts the pelvis at the hip joint
Vastus Lateralis
P: Linea Aspera of the femur
D: Tibial tuberostiy
1. Extends the leg at the knee joint
Vastus Medialis
P: Linea Aspera of the femur
D: Tibial tuberosity
1. Extends the leg at the knee joint
Vastus Intermedius
P: Anterior shaft and the linea aspera of the femur
D: Tibial tuberosity
1. Extends the leg at the knee joint
Pectineus
P: Pubis
D: Proximal posterior shaft of the femur
1. Adducts the thigh at the hip joint
2. Flexes the thigh at the hip joint
3. Anteriorly tilts the pelvis at the hip joint
Adductor Longus
P: Pubis
D: Linea aspera of the femur
1.Adducts the thigh at the hip joint
2.Flexes the thigh at the hip joint
3.Anteriorly tilts the pelvis at the hip joint
GracilisP: Pubis
D: Pes anserine tendon (at the proximal anteromedial tibia)
1. Adducts the thigh at the hip joint
2. Flexes the thigh at the hip joint
3. Flexes the leg at the knee joint
4. Anteriorly tilts the pelvis at the hip joint
Adductor Brevis
P: Pubis
D: Linea aspera of the femur
1.Adducts the thigh at the hip joint
2.Flexes the thigh at the hip joint
3.Anteriorly tilts the pelvis at the hip joint
Adductor Magnus
P: Pubis and Ischium
D: Linea aspera of the femur
1.Adducts the thigh at the hip joint
2.Extends the thigh at the hip joint
3.Posteriorly tilts the pelvis at the hip joint
Biceps Femoris
P: Long head: Ischial tuberosity
Short head: Linea aspera
D: Head of the fibula
1. Flexes the leg at the knee joint (entire muscle)
2. Extends the thigh at the hip joint (long head)
3. Posteriorly tilts the pelvis at the hip joint (long head)
Semitendinosus
P: Ischial tuberosity
D: Pes Anserine tendon
1.Flexes the leg at the knee joint
2.Extends the thigh at the hip joint
3.Poseteriorly tilts the pelvis at the hip joint
Semimembranosus
P: Ischial tuberosity
D: Medial condyle of the tibia
1.Flexes the leg at the knee joint
2.Extends the thigh at the hip joint
3.Posteriorly tilts the pelvis at the hip joint
Have client supine with pillow under kneesPlace palpating hand on the abdomen
between the iliac crest and the 12th rib and palpate deeply with even pressure toward the psoas major. GO SLOW
Ask the client to slowly flex the thigh at the hip joint and feel for contraction of the psoas major
The distal tendon of the psaos major is palpable in the proximal anterior thigh between the pectineus and the sartorius
Have client supine with a pillow under the knees. Have the knee flexed and slightly laterally rotated
Place palpating hand on the anterior iliac crest and palpate into the iliac fossa with your finger tips. Most of the iliacus is not palpable
Ask the client to actively flex the thigh at the hip joint and feel for the contraction of the iliacus
Have client supinePlace palpating hand just distal and slightly
medial to the ASISAsk client to actively flex and laterally rotate
the thigh at the hip joint and feel for the contraction of the sartorius
Continue palpating the sartorius from the ASIS to the pes anserine tendon
To further bring out the muscle give the client resistance
Have client supinePlace palpating hand just distal and slightly
lateral to the ASISHave client actively hold the thigh in a
position of flexion and medial rotation at the hip joint
Resist the client from further flexion of the thigh at the hip joint and feel for the contraction of the TFL
Continue palpating the TFL distally and slightly posteriorly toward ITB attachment
Have client supine with a pillow under their knees
Place palpating hand just proximal to the patellaResist the client from actively extending the leg
at the knee joint and feel for the contraction of the rectus femoris
Continue palpating the muscle toward the ASISTo palpate the proximal attachment passively
flex the thigh at the hip joint and palpate slightly distal to the ASIS
Have client supinePlace palpating hand just distal to the greater
trochanterAsk the client to contract the quadriceps
femoris group and feel for contraction of the vastus lateralis
Continue palpating distally toward the patella
Have client supinePlace palpating hand just proximal and
medial to the patellaAsk the client to contract the quadriceps
femoris group and feel for the contraction of the vastus medialis
Continue palpating the vastus medialis proximally as far as possible
The vastus medialis is best palpated medially in the distal 1/3 of the thigh
Deep and difficult to palpateHave client supinePlace palpating hand just proximal to the patellaIf the rectus femoris can be lifted and/or moved
aside, the distal vastus intermedius may be palpated deep to the rectus femoris when approached from either the medial or lateral side
To feel the vastus intermedius deep to the rectus femoris, make sure that the direction of your pressure is directed toward the middle of the femur
Have the client supine with the their knee resting on a pillow or your inferior thigh
Palpate the medial thigh for the “guitar string” muscle. This is the gracilis
Ask the client to flex the leg at the knee joint against resistance of the table and only the gracilis will contract
Once located continue palpating medially toward the pubic attachment and distally to the pes anserine attachment. Ask the client to adduct the thigh at the hip joint to distinguish it from the semitendinosus
Have the client supine with their thigh flexed at the hip joint and slightly laterally rotated resting their thigh on a pillow or your inferior leg
Place palpating hand on the proximal anteromedial thigh
Ask the client to actively adduct the thigh at the hip joint
Follow the adductor longus’ tendon proximally toward the pubis
The tendon will be just lateral to the attachment of the gracilis
Have the client supinePlace palpating hand just lateral to the pubic
tubercle and feel for the pectineus Continue palpating just lateral and slightly
proximal to the adductor longusTo further bring out the pectineus ask the
client to actively adduct the thigh at the hip joint
The biceps femoris is superficial for most of its course in the posterolateral thigh and is easy to palpate
Have the client prone with the leg partially flexed at the knee joint
Place palpating hand on the distal posterolateral thigh
Resist the client from performing further flexion of the leg at the knee joint and feel for the distal tendon of the biceps femoris
Continue palpating the biceps femoris toward the ischial tuberosity
The semitendinosus is superficial for most of its course in the posteromedial thigh and is easy to palpate
Have the client prone with the leg partially flexed at the knee joint
Place palpating hand on the posteromedial thighFurther resist flexion of the leg at the knee joint
and feel for the distal tendon of the semitendinosus
Continue palpating the muscle proximally toward the ischial tuberosity. Its attachment is just medial to the long head of the biceps femoris
Best palpated distally in the posterior thigh, medial to the belly of the semitendinosus, and on either side of the distal tendon of the semitendinosus
Have the client prone with the leg partially flexed at the knee joint
Place palpating hand on the distal posteromedial thigh
Resist the client from performing further flexion of the leg at the knee joint and feel for contraction of the semimembranosus
The proximal attachment on the ischial tuberosity is lateral to the attachment of the long head of the biceps femoris
Have the client proneFind the ischial tuberosity attachment and
proximal belly of the hamstrings by having the client flex the leg at the knee joint against your resistance.
Locate the medial border of the hamstrings in the proximal thigh.
Palpate just anteromedial to the medial border of the hamstrings for the adductor magnus. This will feel like a natural depressionin the thigh
Continue palpating proximally to the attachment on the ischial tuberosity
Have client proneFollow palpation of the Adductor Magnus The tendon of the adductor brevis is just
medial to the attachment of the adductor magnus on the pubic bone
Have client pronePlace palpating hand just lateral to the sacrum
at a point mid way between the PSIS and the apex of the sacrum
Have client flex the leg at the knee joint to 90 degrees
Have client laterally rotate the thigh at the hip joint against resistance and feel for contraction of the piriformis
Continue palpating laterally to the greater trochanter of the femur
Have client lay pronePlace palpating hand on the lateral sacrumPalpate the gluteus maximus from its medial
attachment (lateral sacrum) to its lateral attachment (ITB)
Have the client actively extend and laterally rotate the thigh at the hip joint to further bring out the muscle.
The gluteus maximus does not cover the entire buttocks; the gluteus medius is just inferior to most of the posterior iliac crest
Have client side lyingMiddle portion: Place palpating hand between the
iliac crest and the greater trochanter of the femur. Ask client to abduct the thigh at the hip joint
Anterior portion: Place palpating hand just posterior and inferior to the ASIS and feel for the anterior fibers. Ask client to flex and medially rotate the thigh at the hip joint.
Posterior portion: Palpate just deep to the superolateral portion of the gluteus maximus and have the client extend and laterally rotate the thigh at the hip joint.
Distinguishing gluteus medius from glut max and piriformis can be difficult
It is difficult to differentiate the gluteus medius from the gluteus minimus because the gluteus medius entirely overlies the gluteus minimus and they have identical actions
Do the same procedure for gluteus medius and palpate deeper