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Anatomy
Subject: Done by: Doctor: Date:
Muscles of the Lower Limb (2)

Doaa' Rawwad

Rashed Jomard Sunday, 25/9/2011

Anatomy Lecture 10/ MSS 2011-9-25 / Sunday

Muscles of the thigh

Please refer to the book and to the mind maps while reading this lecture.

The anterior group of muscles (continued):

The Dr continued what he had started in the previous lecture: Also in the anterior part of the thigh we have another landmark, this landmark is what we call the femoral triangle. Here are the edges of this triangle: - The inguinal ligament - The lateral border of adductor longus - The medial border of Sartorius

The Dr is drawing on the projector: This is the place where you see the femoral canal and we have inside the femoral sheath, we have the femoral vein and the femoral artery, and then outside the sheath we have the femoral nerve. If we want to look for this muscle which is the Iliopsoas or this muscle which is the pectineus you can't see them because they are covered with the neurovascular bundle...

The psoas minor muscle is not constant; you see it in some people and you don't see it in others but you see the psoas major is arising from 15 points; 5 slips and each slip has 3 poinsts of attachment. then this muscle - psoas major- comes down and meets the iliacus muscle which arises from the iliac fossa, and these two muscles join to form one tendon (the same arrangement as that of the quadriceps tendon), and then it will be the iliopsoas muscle, and it is inserted into the lesser trochanter, and it is one of the great flexors of the hip. Now we have an idea about the anterior group of muscles... and here is a quick idea about medial group of muscles.

The medial group of muscles:

The medial group of thigh muscles are named as adductors of the thigh at the hip joint. 1. Pectineus muscle: It originates from superior ramus of pubis, going down and lateral, and then it is attached to the upper part of linea aspera. The pectenius is a "funny!!" muscle some people say it is two muscles because it has a double nerve supply; the femoral nerve and the obturator nerve. 2. Adductor longus: It is just inferior to the pectineus. 3. Adductor brevis: It is posterior to the adductor longus. 4. Adductor magnus: If we remove the two muscles above we will see this muscle (deep to adductor longus and brevis), which is the biggest adductor . It inserts into linea aspera, and it has holes in it. Anterior to these holes we have the profunda femoris artery, and through these holes it sends branches into the posterior group of muscles. 5. gracilis: it is the most medial one

These are the medial group of muscles and they have their own nerve supply which is the obturator nerve, this muscle here -which is the adductor magnus- it has a double nerve supply; the obturator and the sciatic from posterior.

The posterior group of thigh muscles (flexors):

They are called the hamstrings, and they include 3 muscles: 1. biceps femoris : This muscle has two heads; The long head originates from the ischial tuberosity. The short head comes from the posterior part of the femur; linea aspera. We call it biceps femoris to differentiate it from biceps brachialis. Then the two heads come down and insert into the lateral part of the leg; the head of fibula . One year we had this question: - The action of which muscle becomes very painful if we have fracture of the upper end of fibula? You see muscles have attachments; origin and insertion. If you fracture the origin, then the action of this muscle becomes painful! Not weak, but painful. For example, the deltoid muscle is attaches to the clavicle acromion process and spine of the scapula. So if the clavicle is fractured, you should know that any movement of the shoulder will be very painful, so you shouldnt ask the patient to do abduction, it's painful!! He can't do such movements not because the muscle is paralyzed, but because the movement is painful. What happens if the ischial tuberosity is fractured? Then most of the muscles of the thigh will not function because the functioning is painful. So if youre kidding with your friend, and you tell him to sit down on a chair, then you cheat him and you remove the chair O.o and he falls down on his ischeial tuberosity! So if it breaks, he will not be able to flex his thigh because of the pain!

- A question by one of the students: what if the fracture was in the insertion? It will be the same; painful movements. - Another question: how can we tell if the fracture is in the origin or in the insertion of the muscle? By doing an x ray picture. 2. Semimembranosus: when you hold it and you go up, youll see that the tendon of its origin is a membrane; it is a very thin flat aponeurosis, therefore it is called semimembranosus. 3. Semitendinosus: and is so called because when you go to the lab and see the cadaver, youll see that half of it is a tendon and half of it is a muscle; therefore it is called semitendinosis.

Muscles of the leg:

In the leg we have the same problem of the fascia, as we have fascia lata of the thigh (the deep fascia of the thigh), we have in the leg what we call the crural fascia (the deep fascia of the leg) and it is a continuation of the fascia. When there is a fractured bone, then there is an injured blood vessel or there is bleeding. So here you dont see the swelling of the leg, here you see a tense leg! because the fascia will prevent expansion of the leg. So if the leg can't expand to the outside, then it's going to press anything inside the fascia; like the veins and the blood vessels, and you will stop having a peripheral pulse! And you have to immediately put a longitudinal incision to relieve the pressure.

Posterior muscles of the leg:

Now we will talk about the posterior muscles of the leg.We need these muscles during walking, when I walk I land, I unlock the knee then I prepare myself to push myself forward. Once I push myself forward, and I will contract the gluteus maximus. Then when I contract the gluteus maximus, I feel my heel is elevated and I want to continue,

so I need to do planter flexion of the foot so that I will fly; therefore I need a great power. Bur how do I get it? I get it from these muscles: 1. Gastrocnemius: This muscle has two heads crossing the knee and coming from above the condyles of the femur, therefore it has a weak action on the knee joint. Then they join together and form a strong tendon that is inserted into calcaneus bone. 2. Soleus: This muscle is deep to gastrocnemius muscle, arising from fibula, interosseous membrane, and tibia And then coming down and joining the tendon of the gastrocnemius. Then soleus muscle inserts on the upper part of the calcaneus. Now iliopsoas are two muscles that have one tendon, quadriceps muscles are four muscles that form one tendon, and here is another example two muscles that form one tendon. These two muscles -I mean soleus and gastrocnemius - they act together for propulsion; forceful planter flexion. Soleus muscle is full of blood vessels and it is called the second heart. When I contract my soleus, the blood will be pushed upward. When soleus muscle gets stabbed, it will bleed a lot because it is full of veins. Now in the army < fel jaish> the soldiers are supposed to stand for several hours where they are not allowed to do any movement !! even if a fly settles down on your nose :P and that is just to teach them patience they are allowed to do just one movement which is planter flexion to avoid fainting! So once they feel that they are going to faint, they elevate themselves one or two times and stand on their toes, then they come back to their standing position. When they do that they contract their soleus and gastocnemius muscles, and then they feel fresh again

Achilles tendon is the tendon of soleus and gastrocnemius muscles. Achilles is a Greek leader that received an arrow that cut his Achilles tendon, and was not able to walk! So it was named after him. This tendon you can feel it, it's very tough!! In real life you can't cut this tendon even with scissors, the scissors will break!

Now, we need more propulsion, so what do we do? We have more muscles to propel forward. As I said we need gluteus maximus to contract first, then we need planter flexors such as gastrocnemius and soleus, and then the last part that leaves the ground during walking is the big toe; the hallux, therefore we need a strong and a powerful planter flexor of the big toe which is the flexor hallucis longus. 3. flexor hallucis longus: This muscle is oblique to have a little bit extra length. Also this muscle is bipennate; this means that the muscle has central tendon, and the muscle fibers are on both sides of the tendon. And the flesh part is as low as it turns around the medial malleolus of tibia. So this is a very powerful muscle where the flesh or the contractile part on both sides of the central tendon go as down as the medial malleolus. Therefore this is an indication that this is a very powerful muscle because it is oblique, bipennate, and the flesh part is as low. I can't flex the big toe only; I need to flex the other toes as well! If you cut the hallux you can walk but not that efficient! Because the toes can't replace the big toe Now there is a big problem with the big toe if the nail of the big toe grows to the deep, so it becomes painful when pressing on it, therefore you will see that the person is not walking properly So if the right side is painful, you will walk properly on the left side, but on the affected side -which is the right- you extend the big toe so you walk in a way that you can't press on the big toe because that is painful. Youre lucky that we dont give you the walking process as a process! But start to look how people walk, and if you are a very good observer, you can identify where the disease is if someone's way of walking is not that good There are people who have a weak gluteus medius and minimus so they walk this way ((the Dr. start walking in a funny manner )) they cannot stabilize their hips !

Anterior muscles of the leg:

They can be of two types: - If they go anterior and stay anterior, then they are dorsiflexors. - If they go anterior and hook around, then they are planter flexers .

1. Tibialis anterior : This muscle is a good example on a muscle being anterior and a dorsiflexor of the foot at the ankle joint. It's just lateral to tibia, and then it comes down then it becomes a tendon in front of tarsal bones. Because it is in front of tarsal bones, then it's a dorsiflexor muscle, and it also inverts foot at the intertarsal joints. 2. Extensor digitorum longus: It's deeper and lateral to tibialis anterior. As it comes down, it splits into four tendons. Note: it is always better to stick to dorsiflexion and plantar flexion, but some people call the dorsiflexion as extension. 3. Extensor hallucis longus: This muscle is between the tibialis anterior and the extensor digitorum longus. It emerges a tendon. We dont see this muscle because its deep to the two above muscles, it extends the hallux.

Lateral muscles of the leg:

Lateral group of muscles are called peroneus. We have two muscles: Peroneus longus Peroneus brevis The third peroneus muscle which is peroneus tertius belongs to the anterior group of muscles.

They -the lateral muscles- hook around the lateral malleolus, therefore they are planter flexors and evertors.

The Nerve supply

I was asked during the interval about the nerve supply. At this moment the plan of the nerve supply is very simple: - The anterior group of the thigh muscles are supplied by the femoral nerve. - The medial group of muscles -the adductors- are supplied by the obturator nerve. - The posterior group of the thigh muscles are supplied by the sciatic nerve. And the muscles below the knee are supplied by branches of sciatic branches of sciatic such as peroneal nerve and tibial nerve.

Some notes:
- If the lateral rotators of the hip are weak, then the medial rotators are stronger. And those people will walk with an internal rotation of the hip. - Some people walk in a way that their heal doesnt touch the ground, so if the nerve of the dorsiflexors is weak, then the planter flexors are stronger, and arch of the foot will be higher.

- And the same applies to the evertors and to the invertors muscles. - The popliteus muscle in the leg is used to unlock the knee during walking by laterally rotating the femur on the tibia (or medially rotating the tibia). This muscle arises mostly from the tibia above the soleal line. The capsule of the knee -well study it later- it has a hole in it, and this muscle passes through this hole.

- Plantaris muscle is a very small muscle like the Palmaris longus; it has a very short belly and a long tendon.

The Dr said that our knowledge about muscles doesn't end here! We have to study them from the book because the lecture gives headlines only At the end of the lecture the Dr. showed us how to use www.getbodysmart.com to study muscles

THE END

It was a pleasure for me to write this easy lec hope you like it & get benefit sorry for any mistake and sorry if it was done lately but be sure that it was out of my hands !!! 2keed ma ra7 2nsa 27keelek shokran ,, my sis and my best frn 3hed <3 <3 thanks for everything 3hed mn elboshar lal 6eba3a :PPPP may 2lla bless u hny <3 And special thanks for u nadia hawash 3la el flash memory :PP ya 27la jarah

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