MUSCLES OF LOWER LIMB

Dr .BALRAJ NAIDU PG IN MS (ORTHO)GANDHI MEDICAL COLLEGE

BY

GLUTEUS MAXIMUS

• ORIGIN: ILIAC CREST ILIUM SACRUM COCCYX SACRO TUBEOUS LIGAMENTS POSTERIOR GLUTEAL LINE FACIA COVERING G.MEDIUS

• INSERTION: GLUTEAL TUBEROSITY ( greater part of muscle inserted into ilio tibial tract)• NERVE SUPPLY :INFERIOR GLUTEAL NERVE• ACTION : Chief EXTENSOR OF THIGH ER & ABDUCTION OF THIGH With TFL Stabilises knee through IBT

Clinical Anatomy

GLUTEUS MEDIUS

ORIGIN : ILIUM…Gluteal surface B/w ant & post gluteal lineINSERTION : GREATER TROCHANTER on lat surfN/S : SUPERIOR GLUTEAL NERVEACTION : INTERNAL TOTATION OF HIP ABDUCTION OF THIGH

GlUTEUS MINIMUS

ORIGIN : ILIUM b/w anterior and inferior gluteal lineINSERTION : Greater trochanter lat surface N/S : Superior gluteal nerve ACTION : INTERNAL TOTATION OF HIP ABDUCTION OF THIGH

TENSOR FACIA LATA

• ORIGIN Iliac Crest :-anterior 5cm of outer lip• INSERTION 3-5cm below gluteal tuberosity• N/S Superior gluteal nerve L4,L5,S1• ACTION TFL Stabilises knee through ITT

Clinical significance of G.Med ,Min

SHORT EXTERNAL ROTATORS OF HIP

PIRIFORMIS

ORIGIN : S2,S3,S4 pelvic surface by 3 digitations Greater sciatic notch upper part INSERTION : GT apex N/S : Ventral rami of S1,S2 ACTION : ER of thigh at hip joint

GEMELLI SUPERIOR

ORIGIN : Lesser sciatic notch upper part

INSERTION : GT medial surface tendon blend with tendon obturator internus

N/S : Nerve to obturator internus L5,S1,S2

ACTION : ER of thigh

GEMELLI INFERIOR

ORIGIN : Lesser sciatic notch upper partINSERTION : GTMedial surface tendon blends with tendon of obturator internus.N/S : Nerve to Quadratus femoris L4,L5,S1ACTION : ER of thigh

OBTURATOR INTERNUS

ORIGIN : Ilium :- Below pelvis brim Ischium :- pelvic surface of body Ischial tuberosity Ischio pubic rami Obturator membrane :- pelvic surfacINSERION : GT medial surface N/S : Nerve to obturator internus L3,S1,S2ACTION : ER of thigh

OBTURATOR EXTERNUS

ORIGIN : Obturator membrane :-outer surface Obturator foramen :- outer surfaceINSERTION : GT medial surface N/S : Obturator nerve posterior division L2,L3,L4ACTION : ER of thigh

QUADRATUS FEMORIS

ORIGIN : Ischial tuberosityINSERTION : Quadrate tubercleN/S : Nerve to Quadratus femoris L4,L5,S1ACTION : ER of thigh accessory function MR , ABDUCTION EXTENSOR of knee

SARTORIUS

ORIGIN : ASIS INSERTION : Tibia :- upper part of medial surface shaft of tibia infront of Gracilis and SEMI TEND N/S : Femoral nerveACTION : EXTERNAL ROTATION and ABDUCTION OF THIGH FLEXION OF LEG AT KNEE

QUADRICEPS FEMORIS

RECTUS FEMORIS

ORIGIN : Straight head :- AIIS Reflected head :- acetabulum margin capsule of hip jt INSERTION : Patella : - bone N/S : Femoral nerveACTION : EXTENSION OF KNEE

VASTUS LATERALIS

ORIGIN : GREATER TROCHANTER Anterior and Inferior border

Inner trochanter :- upper part Gluteal tuberosity :- lateral lip Linea aspera :- lateral lip U 1/3 INSERTION : Patella :- bone N/S : Femoral nerve ACTION : EXTENSION OF KNEE

VASTUS MEDIALIS

ORIGIN : Inter trochanteric line lower part linea aspera :- medial lip Spiral line Medial supra condylar line :- U ¼INSERTION : Patella :- bone N/S : Femoral nerve ACTION : EXTENSION OF KNEE

VASTUS INTERMEDIUS

ORIGIN : Shaft of femur U3/4 Anterior and lateral surface INSERTION : Patella :- boneN/S : Femoral nerve ACTION : EXTENSION OF KNEE

HAMSTRING MUSCLES

BICEPS FEMORIS

LONG HEAD : Ischial tuberosity with semi tendonosis sacro tuberal ligamentSHORT HEAD : Linea aspera lateral lip B/w vastus lateralis and adductor magnus lateral supracondylar line Lateral intermuscular septumINSERTION : Head of fibula N/S : Long head :- tibial part of sacral nerve L5,S1,S2 : Short hand :- common peroneal nerve of sacral nerve ACTION : LONG HEAD:- Chief flexor of knee Lateral rotation of leg in semiflexed knee : SHORT HEAD :- Weak extension of hip

SEMI TENDANOSIS

ORIGIN : Ischial tuberosity with long head of biceps INSERTION : Tibia :- upper part of medial shaft of tibia behind sartorius , gracilis N/S : Tibial part sacral nerve L5,S1,S2ACTION : : Chief flexor of knee Lateral rotation of

leg in semiflexed knee Weak extension of hip

SEMI MEMBRINOSUS

ORGIN : Ischial tuberosityINSERTION : Tibia :- medial condyle of posterior

surface N/S : Tibial part of L5,S1,S2 ACTION :

Chief flexor of knee Lateral rotation of leg in semiflexed knee Weak extension of hip

ADDUCTOR MAGNUS

ORIGIN : Ischium :- Ischial tuberosity ischium Pubis :- Inferior pubic ramiINSERTION : Gluteal tuberosity Linea aspera Medial supra condylar line Adductor tubercleN/S : HAMSTRING Part By tibial Part of siactic nerve ADDUCTOR Part By OBTURATOR nerve posterior division

ACTION : EXTENTION at Hip FLEXION at Knee

CLINICAL TESTING OF HAMSTRINGS

ER OF HIP

MEDIAL COMPARTMENT OF THIGH

ADDUCTOR LONGUS

ADDUCTOR BREVIS

ADDUCTOR MAGNUS

ADDUCTOR LONGUSORIGIN : Pubis :body of pubis in the angle b/w pubic symphysis and pubic crest INSERTION : Linea aspera :- M/3 shaft b/w VM, AM,ABN/S : Obturator nerve – anterior

ACTION : Adductor of thigh

ADDUCTOR BREVISORIGIN : Pubis :- . body of pubis .Inferior pubic rami b/w gracilis and obturator externus Ischium :- . Outer surface of ramus of ischium b/w gracilis and adductor magnus .

INSERTION : line extending from lesser trochanter to upper part of linea aspera behind upper part of adductor longusN/S : OBTURATOR NERVE ANT DIV

ACTION : ADDUCTION Of Thigh

ADDUCTOR MAGNUSORIGIN : Ischium :-Ischial tuberosity Ramus of ischium Pubis :- Inferior pubic ramus

INSERTION : Gluteal tuberosity lInea aspera Medial supracondylar line Adductor tubercle

N/S : Adductor part :- obtuator nerve – posterior division : Hamstring part :- Tibial part of sciatic nerve

ACTION : Adductor magnus :- lower part helps in extension of hip , flexon of knee

Clinical testing of adductors

GracilisORIGIN : Pubis :- Medial margin of lower half of body of pubis Inferior pubic rami Ischium :- Rami of ischium INSERTION : Tibia :- upper part , medial surface infront of STN/S : Obturator nerve – Anterior

ACTION : Flexion and medial rotation of thigh Weak adduction of thigh

PECTINEUS

ORIGIN : Pubis :- Superior pubic rami Pectin pubis Fascia Over Pectineus

INSERTION : Line extended from lesser trochanter to linea aspera

N/S : Anterior fibre : Femoral N Posterior fibre : Obturator N

ACTION : Adductor and flexon of thigh

MUSCLE OF POSTERIOR ABDOMINAL WALL

PSOAS MAJOR

PSOAS MINOR

ILIACUS

QUADRATUS LUMBORUM

PSOAS MAJOR

ORIGIN : All lumar vertebra L1-L5 from anteior surface and lower border of transverse process L1-L5 By 5lips one each from bodies of adjacent vertebra intravertebral disc of T12-L5 INSERTON : Lesser trochanter of femur muscle pass behind the inguinal ligament nd infront of hip joint to enter into thigh It ends in a tendon which receives fibres of iliacus on its lateal side

N/S : Branch of roots of spinal nerve L2,L3,L4

ACTON :- Ileao-psos – power of flexor of hip

PSOAS MINOR

ORIGIN : Sides of bodies of T12 and L1INSERETION : PECTIN PUBIS ILIO PUBIC EMINENCEN/S : Br of L1ACTION : Weak Flexor Of HIP

ILIACUS

ORIGIN : ILIAC CREST Inner lip ILIAC FOSSA SACRUMINSERTION : Lesser TrochanterN/S : Br of FEMORAL NERVEACTION : Flexion of Hip

QUADRATUS LUMBORUMORIGIN : L5 Transverse process belowINSERTION : L1 – L4 Transverse process above 12th RIBN/S : SPINAL NERVES T12 – L4ACTION : EXTENTION OF LUMBAR VERTEBRAE FLEXION OF 12TH RIB during inspiration

CLINICAL TESTING OF MUSCLES

Muscles producing movements at hip joint

Movement Chief muscles Accessory muscles

Flexion Psoas major and iliacus Pectinius,rectus femoris,and sartorius,adductors(mainly adductor longus )participate in early stagesExtension Gluteus maximus and ---------------------------- Hamstrings Adduction Adductor longus,brevis,magnus Pectinius and gracilis

Abduction Glutei medius and minimus Tensor fascia lata and sartorius

Medial rotation TFL,anterior fibres of G.Med,G.Min ------------------------------ Lateral rotation 2obturators,2gemelli,and quadratus Piriformis,gluteus maximus, femoris sartorius

Muscles producing movement at knee joint

Movement Principal muscles Accessory muscles

Flexion Biceps femoris Gracilis Semitendinosus Sartorius Semimembranosus Popliteus

Extension Quadriceps femoris TFL

Medial rotation PopliteusOf flexed leg Semimembranosus Sartorius Semitendinosus Gracilis

Lateral rotation Biceps femoris ------------------------Of flexed leg

MUSCLES OF ANTERIOR COMPARTMENT OF LEG

TIBIALIS ANTERIOR

EXTENSOR HALLUCIS LONGUS

EXTENSOR DIGITORUM LONGUS

PERONEUS TERTIUS

EXTENSOR DIGITORUM BREVIS

TIBIALIS ANTERIORORIGIN : Tibia :- lateral condyle U2/3 lateral surface of shaft Inter osseous membrane

INSERTION : Medial cuneiform :- infro medial surface 1st MT :- Base

N/S : Deep peroneal nerve ACTION : Dorsiflexion at foot Inverter of foot Maintain medial longitudinal arch of foot

EXT HALLUCIS LONGUS

ORIGIN : Fibula :-middle 2/4 shaft post surface

INSERTION : Distal phalynx of great toe :-Dorsal surfaceN/S : Deep peroneal nerve ACTION : Dorsi flexion of foot Extensin of MTP , Keep leg verticle while walking on uneven ground

EXTENSOR DIGITORIUM LONGUS ORIGIN : Tibia :- Lateral condyle Fibula :- U ¼ whole side Middle :- anterior half Interosseous membraneINSERTION : Middle and distal phalanges of 2nd and 5th toe Muscle divide into 4 tendons for 2ndto 5th toe Each tendon is joined on lateral side by tendon of ext digitobrevis and form dorsal digital expantion

N/S : Deep peroneal nerve

ACTION : Dorsiflexion of foot Extends MTP ,IP5 of 2nd and 5th toe

PERONEUS TERTIUS

ORIGIN : Fibula :- L/4 medial surface shaft

INSERTION : 5th MT – medial surface of dorsal surface

N/S : Deep peroneal nerve ACTION : Dorsiflexion and inverter of foot

EXTENSOR DIGITORIUM BREVIS

N/S : Deep peroneal nerve

ACTION : EHB :- Extends MTP of great toe Other extends MTP ,IP5 OF 2ND ,3RD,4TH toes

ORIGIN : Calcaneus anterior surface INSERTION : Proximal phalynx of 1st – 4th toes Muscle divides into 4 tendons for medial 4th toe medial most part of muscle called as extensor hallucis brevis Lateral 3 tendons join lateral side of EDL for dorsal digital expansion of 2nd ,3RD ,4th

toe

2 MUSCLES OF LATERAL SIDE OF LEG

PERONEUS LONGUS

PERONEUS BREVIS

PERONEUS LONGUS

ORIGIN : Fibula :- Head of fibula Lateral surface of shaft Medial 1/3 of fibula INSERTION : Medial cuneaform same as T.ant 1st MT N/S : Superior peroneal nerveACTION : Evertor of foot Maintains lateral longitdinal transerve arch

PERONEUS BREVIS

• ORIGIN : Fibula :- L/3 Lateral surface of shaft

• INSERTION : 5th MT

• N/S : Superficial peroneal nerve

• ACTION : Evertor of foot

MUSCLES OF MEDIAL SIDE OF LEG

• SARTORIUS • GRACILIS• SEMITENDANOSUS

SUPERFICIAL MUSCLES OF BACK OF LEG

. GASTROCNEMIUS

. SOLEUS

. PLANTARIS

GASTROCNEMIUSORIGIN : Medial Head :- medial condyle of femur popliteal surface of femur capsule of knee joint Lateral head :- lateral condyle of femur lateral supracondylar line capsule of kneeINSERTION : Calcaneous :- Tendons of gastrocnemius fuses with soleus for tendon achilis inserted on M/3 of posteior surface of calcaneous

N/S : Tibial nerve S1,S2 ACTION : Plantar flexion foot imp for walking Flexor of knee

SOLEUSORIGIN : Tibia :- soleal line and m/3 of post surface of shaft Fibula :- Base of head U/4 post surface of shaft INSERTION : Calcaneous:- Tendon of gastorcnemus fuses with tendon of soleus form tendon achillis inserted on M/3 of posteior surface of calcaneousN/S : Tibial nerve S1/S2ACTION : PLANOR FLEXION OF FOOT

PLANTARISORIGIN : FEMUR : Lateral condyle Oblique popliteal line INSERTION : Calcaneous:- posteior surface of calcaneum medial to TAN/S : Tibial nerve S1/S2ACTION : Plantar is rudimentary Accessory to gastrocnemeus Importance of

DEEP MUSCLES OF BACK OF LEG

. POPLITEUS

. FLEXOR HALLUCIS LONGUS

. FLEXOR DIGITORUM LONGUS

. TIBIALIS POSTERIOR

POPLITEUS

ORIGIN : Femur :- Lateral condyle Lateral meniscusINSERTION : Tibia :- post surface shaft of tibia above soleal lineN/S : Tibial nerve ACTION : Unlocking of knee by lateral rotations of femur on tibia bigining of flexion

FlEXOR HALLUCIS LONGUS

ORIGIN : Fibula :- lower ¾ post surface

INSERTION : Distal phalynx of big toe

N/S : Tibial nerve ACTION : Flexion of distal phalnx of great toe

FLEXOR DIGITORIUM LONGUS

ORIGIN : Tibia :-U/3post surface below soleal lineINSERTION : Distal phalanx of 2nd -5th toe Muscle divides into 4 tendons for lateral 4 toes N/S : Tibial nerveACTOIN : Flexor of digital phalanx 2-5th toes Plantar flexon of foot at ankle

TIBIALIS POSTERIORORIGIN : Tibia :- u2/3 posterior surface below soleal line Fibula :- Posterior surface of fibula INSERTION : Tuberosity of navicular bone and tarsal bones except talus Insert extends to 2nd ,3rd,4th,MT at baseN/S : Tibial nerve ACTION : Plantar flexion at ankle Inversion at foot at subtalar joint Maintains medial longitudinal arch

Muscles producing movements at ankle joint

Movement Principal muscles Accesory muscles

Dorsiflexion Tibialis anterior Extensor digitorum longus Extensor hallucis longus

Peroneus longus

Plantarflexion Gastrocnemius Plantaris Soleus Tibialis posterior Flexor hallucis longus Flexor digitorum longus

Muscles producing movement of inversion and eversion

Movement Principal muscles Accesssory muscles

Inversion Tibialis anterior Flexor hallucis longus Tibialis posterior Flexor digitorum longus

Eversion Peroneus longus Peroneus tertius Peroneus brevis

3 MUSCLES OF 1ST LAYER of Sole

FLEXOR DIGITORUM BREVIS

ABDUCTOR HALLUCIS

ABDUCTOR DIGITI MINIMI

FLEXOR DIGITORIUM BREVISORIGIN : Calcaneous :- medial tubercle Plantar aponeurosis Intermuscular septa

INSERTION : Middle phalanx of 2nd -5th toe Muscle ends in 4 tendons 2-5th DP opp bone of proximal phalanx each tendon divides in to 2 slips

N/S : Medial plantar nerve

ACTION : Flexion of toes at MTP ,IP5

ABDUCTOR HALLUCIS

ORIGIN : Calcaneous :- medial tubercle Flexor retinaculum Intermuscular sept

INSERTION : Medial side of proximal phalanx of 1st toe Tendon of abductor hallucis fuses with

tendon of flexor hallucis brevis

N/S : Medial plantar nerve

ACTION : Abductor of great toe

ABDUCTOR DIGITI MINIMIORIGIN : Calcaneus FR Inter muscular septaINSERTION : Lateral side of Proximal phalanx of 5th toe Tendon fuses with tendon of flexor digiti mini brevis inserted into lateral side of pp of 5th toeN/S : Medial plantar nerve

ACTION : Abductor of LT

4MUSCLES OF 2ND LAYER

• FLEXOR DIGITORIUM LONGUS

. FLEXOR DIGITORIUM ACCESSORIUS

. LUMBRICLES

. FLEXOR HALLUCIS LONGUS

FLEXOR DIGITORUM LONGUSORIGIN : Tibia : u/3 posterior surface tibia below soleal line INSERTION : distal phalanx of 2nd to 5th toe

N/S : Tibial nerve ACTOIN : Plantar flexion of ankle 2nd to 5th toe

FLEXOR DIGITORUM ACCESSORI

ORIGIN : Medial head :- calcanium Lateral head :- calcaniumINSERTION : Distal phalanx of 2nd to 5th toe Muscle fibres insert on to lateral side of tendons of FDL N/S : Lateral plantar nerve ACTION : plantar felxion of ankle of 2nd -5th toe

LUMBRICLESORIGIN : 1ST :-medial side of 1st FDL OF 2ND toe 2nd :-adjacent side of tendon of 1st and 2nd FDL 3RD :-adjacent side of tendon of 2nd and 3rd FDL 4TH :-Adjacent side of tendon of 3rd and 4th FDL INSERTION : MTP of lateral four toes dorsally for insertion into extensor expansion

N/S : 1st :- Medial plantar nerve 2nd -4th :- lateral plantar nerve

ACTION : Extension of IPJ Toes dosent buckle while walking

FLEXOR HALLUCIS LONGUSORIGIN : Fibula :- L3/4 post surface

INSERTION : Distal phalanx of 1st toe

N/S : Tibial nerve

ACTION : Plantar flexion of big toe ,Ankle

Maintaines Median long arch

3 MUSCLES OF 3RD LAYER

. FLEXOR HALLUCIS BREVIS

. ADDUCTOR HALLUCIS

. FLEXOR DIGITI MINIMI BREVIS

FLEXOR HALLUCIS BREVIS ORIGIN : Arises by ‘Y’ shaped tendon Medial limb :- direct conitnuation of tibialis posterior Lateral limb:- cuboidINSERTION : Proximal phalanx of GT muscle divides into medial and lateral part each tendon inserted into corresponding sides N/S : Medial plantar nerve ACTION : Flexor of pp at GT

ADDCUTOR HALLUCISORIGIN : Oblique head :- 2nd 3rd MT sheath of peroneus longus Transerve head :-long plantar ligaments of MTP joints of 3rd 4th 5th joints Deep MT ligaments INSERTION : Lateral side of proxiaml phalanx of GT Common with lateral tendon of flexor hallucis brevisN/S : Deep lateral plantar nerve

ACTION : Addcutor of GT

FLEXOR DIGITI MINI BREVIS

ORIGIN : 5MT Tendon of peroneus longus

INSERTION : lateral side of proximal phalan of LT N/S : Superficial lateral plantar nerve

ACTION : Flexor of pp of LT

4 MUSCLES OF 4TH LAYER

• DORSAL INTEROSSEI

• PLANTOR INTEROSSEI

• TIBIALIS POSTERIOR

• PERONEUS LONGUS

DORSAL INTEROSSEIORIGIN : ALL MT :- adjacent sides INSERSTION : Proximal phalanx of 2nd to 5th toe 1ST :- medial side of pp 2nd toe 2ND :-lateral side of pp 3rd toe 3rd :- lateral side of pp 4th toe 4th :- lateral side of pp 5th toe N/S : lateral plantar NerveACTION : DAB

PLANTAR INTEROSSEI

ORIGIN : 3rd ,4th,5th,MT :- medial side INSERTION : Proximal phalanx 3rd ,4th,5th,N/S : lateral plantar Nerve ACTION : PAD

TIBIALIS POSTERIORORIGIN : Tibia :- u2/3 posterior surface below soleal line Fibula :- Posterior surface of fibula INSERTION : Tuberosity of navicular bone and tarsal bone except talus Insert extends to 2nd ,3rd,4th,MT at baseN/S : Tibial nerve ACTION : Plantar flexion at ankle Inversion at foot at subtalar joint Maintains medial longitudinal arch

PERONEUS LONGUS

ORIGIN : Fibula :- Head of fibula Lateral surface of shaft Medial 1/3 of fibula INSERTION : Medial cuneaform same as T.ant 1st MT N/S : Superior peroneal nerveACTION : Evertor of foot Maintains lateral longitdinal

transverse arch

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