Femur & Knee Muscles Flashcards
Anterior Femoral Group:
Tensor Fascia Lata:
O: anterior part of the external lip of the iliac crest, outer surface of the anterior superior iliac spine (ASIS) & deep surface of the fascia lata
I: into the iliotibial tract of the fascia lata at the junction of the proximal and middle thirds of the thigh
A: flexes, medially rotates & abducts the hip joint, tenses the fascia lata and may assist in knee extension
N: superior gluteal nerve (L4, L5, S1)
Muscle Testing: Tensor Fascia Lata:
Patient: supine
Fixation: none
Test: abduction, flexion and medial rotation of the hip with the knee extended
Pressure: against the leg, flexion of the arm.
Anterior Femoral Group
Sartorius:
O: anterior superior iliac spine (ASIS) & superior half of the notch just distal to the spine
I: proximal part of the of the medial surface of the tibia near the anterior border (pes anserine)
A: flexes, laterally rotates & abducts the hip joint; flexes and assists in medial rotation of the knee joint
N: femoral nerve (L2, L3, L4)
NOTE: The Sartorius is the LONGEST muscle in the human body!
Muscle Testing: Sartorius:
Patient: supine
Fixation: none
Test: lateral rotation, abduction and flexion of the thigh with flexion of the knee
Pressure: against the anterolateral surface of the lower thigh. resisting lateral rotation by pressure and counter pressure
Anterior Femoral Group - Quadriceps:
Rectus Femoris:
O: straight head: from anterior inferior iliac spine (AIIS)
reflected head: from groove above rim of acetabulum
I: proximal border of the patella & through the patellar ligament to the tibial tuberosity via the common quadriceps tendon & patellar ligament
A: extension of knee & flexion of the hip
N: femoral nerve (L2, L3, L4)
NOTE: this muscle is the only quad muscle to act on both hip and knee joints
Muscle Testing: Quadriceps Femoris:
Patient: sitting
Fixation: none
Test: full extension of knee joint
Pressure: against the leg, above the ankle
Anterior Femoral Group - Quadriceps:
Vastus Lateralis:
O: proximal part of intertrochanteric line, anterior & inferior borders of the greater trochanter, lateral lip of the gluteal tuberosity, proximal half of lateral lip of the linea aspera & lateral intermuscular septum
I: proximal border of the patella, through the patellar ligament to the tibial tuberosity via the common quadriceps tendon & patellar ligament
A: knee extension
N: femoral nerve (L2, L3, L4)
Muscle Testing: Quadriceps Femoris:
Patient: sitting
Fixation: none
Test: full extension of knee joint
Pressure: against the leg, above the ankle
Anterior Femoral Group - Quadriceps:
Vastus Intermedius:
O: anterior & lateral surfaces of the proximal 2/3 of the body of the femur, distal half of the linea aspera & lateral intermuscular septum
I: proximal border of the patella & through the patellar ligament to the tibial tuberosity via the common quadriceps tendon & patellar ligament
A: knee extension
N: femoral nerve (L2, L3, L4)
Muscle Testing: Quadriceps Femoris:
Patient: sitting
Fixation: none
Test: full extension of knee joint
Pressure: against the leg, above the ankle
Anterior Femoral Group - Quadriceps:
Vastus Medialis:
O: distal half of the intertrochanteric line, medial lip of the linea aspera, proximal part of the medial supracondylar line, tendons of the adductor longus & magnus and medial intermuscular septum
I: proximal border of the patella & through the patellar ligament to the tibial tuberosity via the common quadriceps tendon & patellar ligament
A: knee extension
N: femoral nerve (L2, L3, L4)
Muscle Testing: Quadriceps Femoris:
Patient: sitting
Fixation: none
Test: full extension of knee joint
Pressure: against the leg, above the ankle
Anterior Femoral Group:
Articularis Genu:
O: anterior surface of the distal part of the body of the femur
I: proximal part of the synovial membrane of the knee joint
A: draws the articular capsule proximally
N: branch of the nerve to the vastus intermedius (off femoral nerve)
Medial Femoral Group
Pectineus:
O: surface of the superior ramus of the pubis, ventral to the pecten, between the iliopectineal eminence & the pubic tubercle on the ‘pectineal line’ of pubis
I: pectineal line of femur
A: adduction & flexion of the hip
N: femoral nerve (L2, L3) and obturator nerve (L2, L3, L4)
Muscle Testing: Hip Adductors:
Patient: sidelying
Fixation: examiner holds upper leg in abduction
Test: adduction of the underneath leg upward from the table in neutral
Pressure: against the medial aspect of the distal end of the thigh, pressure is applied above the knee
Medial Femoral Group
Adductor Brevis:
O: outer surface of the inferior ramus of the pubis
I: distal 2/3 of the pectineal line & proximal 1/2 of the medial lip of the linea aspera
A: adduction & flexion of hip joint
N: obturator nerve (L2, 3, 4)
Muscle Testing: Hip Adductors:
Patient: sidelying
Fixation: examiner holds upper leg in abduction
Test: adduction of the underneath leg upward from the table in neutral
Pressure: against the medial aspect of the distal end of the thigh, pressure is applied above the knee
Medial Femoral Group:
Adductor Longus:
O: anterior surface of pubis at the junction of the crest & the symphysis
I: middle 1/3 of the medial lip of the linea aspera
A: adduction & flexion of hip joint
N: obturator nerve (L2, 3, 4)
Muscle Testing: Hip Adductors:
Patient: sidelying
Fixation: examiner holds upper leg in abduction
Test: adduction of the underneath leg upward from the table in neutral
Pressure: against the medial aspect of the distal end of the thigh, pressure is applied above the knee
Medial Femoral Group
Adductor Magnus:
O: inferior pubis ramus, ramus of the ischium (anterior fibers) & ischial tuberosity (posterior fibers)
I: medial to the gluteal tuberosity, middle of the linea aspera, medial supracondylar line, and adductor tubercle of the medial condyle of the femur
A: anterior fibres: adduction & assistance with flexion
A: posterior fibres: adduction & extension
N: obturator nerve (L2, L3 ,L4) & sciatic nerve (L4, L5, S1)
Muscle Testing: Hip Adductors:
Patient: sidelying
Fixation: examiner holds upper leg in abduction
Test: adduction of the underneath leg upward from the table in neutral
Pressure: against the medial aspect of the distal end of the thigh, pressure is applied above the knee
Medial Femoral Group
Gracilis:
O: inferior ½ of the symphysis pubis & medial margin of the inferior ramus of the pubic bone
I: medial surface of the body of the tibia, distal to the condyle, proximal to the insertion of the semitendinosus and lateral to the insertion of the sartorius (pes anserine).
A: adduction of hip, flexion and medial rotation of the knee
N: Obturator nerve (L2, L3, L4)
Muscle Testing: Hip Adductors:
Patient: sidelying
Fixation: examiner holds upper leg in abduction
Test: adduction of the underneath leg upward from the table in neutral
Pressure: against the medial aspect of the distal end of the thigh, pressure is applied above the knee
Posterior Femoral Group: Hamstrings:
Biceps Femoris:
O: long head: distal part of the sacrotuberous ligament and posterior part of the tuberosity of the ischium
O: short head: lateral lip of the linea aspera, proximal 2/3 of the supracondylar line, and lateral intermuscular septum
I: lateral side of the head of the fibula, lateral condyle of the tibia & deep fascia on the lateral side of the leg
A: the long & short heads of the biceps femoris flex & laterally rotate the knee joint, in addition, the long head extends & assists in lateral rotation of the hip joint
N: long head: sciatic nerve: tibial branch (L5, S1, S2, S3 )
N: short head: sciatic nerve: peroneal (fibular) branch (L5, S1, S2)
Muscle Testing: Biceps Femoris:
Patient: prone
Fixation: examiner holds the thigh firmly down on the table
Test: flexion of knee (50-70 degrees), thigh in slight lateral rotation
Pressure: against the leg, proximal to the ankle
Posterior Femoral Group: Hamstrings:
Semimembranosus:
O: tuberosity of the ischium, proximal & lateral to the biceps femoris and the semitendinosus
I: posteromedial aspect of the medial condyle of the tibia
A: flexes & medially rotates the knee joint, extends & assists in medial rotation of the hip joint
N: sciatic nerve: tibial branch (L4, L5, S1, S2)
Muscle Testing: Semimembranosus & Semitendinosus:
Patient: prone
Fixation: examiner holds the thigh firmly down on the table
Test: flexion of knee (50-70 degrees), thigh in slight medial rotation
Pressure: against the leg, proximal to the ankle
Posterior Femoral Group: Hamstrings:
Semitendinosus:
O: tuberosity of the ischium by the tendon common with the long head of the biceps femoris
I: proximal part of the medial surface of the body of the tibia and deep fascia of the leg
A: flexes & medially rotates the knee joint, extends and assists in medial rotation of the hip joint
N: sciatic nerve: tibial branch (L4, L5, S1, S2)
Muscle Testing: Semimembranosus & Semitendinosus:
Patient: prone
Fixation: examiner holds the thigh firmly down on the table
Test: flexion of knee (50-70 degrees), thigh in slight medial rotation
Pressure: against the leg, proximal to the ankle
Anterior Crural Muscle Group:
Tibialis Anterior:
O: lateral condyle and proximal half of the lateral surface of the tibia, interosseous membrane, deep fascia and lateral intermuscular septum
I: medial and plantar surface of the medial cuneiform bone, base of the first metatarsal bone
A: dorsiflexes the ankle joint, and assists in inversion of the foot -subtalar joint
N: deep peroneal (fibular) nerve (L4, L5, S1)
Muscle Testing: Tibialis Anterior
Patient: supine or sitting
Fixation: examiner supports the leg just above the ankle joint
Test: dorsiflexion of ankle joint and inversion of foot
Pressure: against the medial side, dorsal surface of the foot
Anterior Crural Muscle Group:
Extensor Digitorum Longus:
O: lateral condyle of the tibia, proximal ¾ of the anterior surface of the body of the fibula, proximal part of the interosseous membrane, adjacent intermuscular septa & deep fascia
I: by 4 tendons to the 2-5 digits. Each tendon forms an expansion on the dorsal surface of the toe and divides into an intermediate slip attached to the base of the middle phalanx, and into two lateral slips attached to the base of the distal phalanx
A: extends the metatarsophalangeal (MTP) joints, and assists in extending the interphalangeal (IP) joints of the 2-5 digits, assists in dorsiflexion of the ankle joint & eversion of the foot (subtalar)
N: deep Peroneal (fibular) nerve (L4, L5, S1)
Muscle Testing:
Extensor Digitorum Longus and Brevis:
Patient: supine or sitting
Fixation: examiner stabilizes the foot in slight plantar flexion
Test: extension of all joints of the 2-5 digits
Pressure: against the dorsal surface of the toes
Anterior Crural Muscle Group:
Extensor Hallucis Longus:
O: middle two quarters of the anterior surface of the fibula & adjacent interosseous membrane
I: base of the distal phalanx of the great toe
A: extends the metatarsophalangeal & interphalangeal joints of the great toe, and assists in inversion of the foot dorsiflexion of the ankle joint
N: deep peroneal (fibular) nerve (L4, L5, S1)
Muscle Testing:
Extensor Hallucis Longus & Brevis:
Patient: supine or sitting
Fixation: examiner stabilizes the foot in slight plantar flexion
Test: extension of the metatarsophalangeal and interphalangeal joints of the big toe
Pressure: against the dorsal surface of the big toe
Anterior Crural Muscle Group
*Fibularis (Peroneus) Tertius:
O: distal 1/3 of the anterior surface of the fibula, interosseous membrane and adjacent intermuscular septum
I: dorsal surface, base of the 5th metatarsal
A: dorsiflexes ankle joint, and everts foot
N: Deep peroneal (fibular) nerve (L4, L5, S1)
Muscle Testing: Fibularis (Peroneus) Tertius:
Patient: supine or sitting
Fixation: examiner supports the leg above the ankle joint
Test: dorsiflexion of the ankle with eversion of the foot
Pressure: against the lateral side, dorsal surface of the foot
Lateral Crural Muscle Group:
Fibularis (Peroneus) Longus:
O: lateral condyle of the tibia, head & proximal 2/3 of the lateral surface of the fibula, intermuscular septa & adjacent deep fascia
I: lateral side of the base of the first metatarsal and of the medial cuneiform bone
A: everts the foot, assists in plantar flexion of the ankle joint & depresses the head of the 1st metatarsal
N: Superficial peroneal (fibular) nerve (L4, L5, S1)
Muscle Testing:
Fibularis (Peroneus) Longus and Brevis:
Patient: supine with lower extremity medially rotated
Fixation: examiner supports the leg above the ankle joint
Test: plantarflexion of the ankle with eversion of the foot
Pressure: against the lateral side of sole of foot
Lateral Crural Muscle Group
Fibularis (Peroneus) Brevis:
O: distal 2/3 of the lateral surface of the fibula & adjacent intermuscular septa
I: tuberosity of the base of the 5th metatarsal bone, lateral side
A: everts the foot and assists in plantar flexion of the ankle
N: Superficial peroneal (fibular) nerve (L4, L5, S1)
Muscle Testing:
Fibularis (Peroneus) Longus and Brevis:
Patient: supine with lower extremity medially rotated
Fixation: examiner supports the leg above the ankle joint
Test: plantarflexion of the ankle with eversion of the foot
Pressure: against the lateral side of sole of foot
Posterior Crural Muscle Group:
Gastrocnemius:
O: medial head: proximal & posterior part of the medial condyle & adjacent part of the femur, capsule of the knee joint
O: lateral head: lateral condyle and posterior surface of the femur, capsule of the knee joint
I: middle part of the posterior surface of the calcaneus
A: plantarflexion of foot (weak knee flexion & inversion of foot?)
N: Tibial nerve (S1, S2)
Muscle Testing: Ankle Plantar Flexors: Gastrocnemius & Plantaris:
Patient: standing
Fixation: none
Test: rising on toes
Pressure: against weight of the body’s
Posterior Crural Muscle Group:
Plantaris:
O: distal part of the lateral supracondylar line of the femur, adjacent part of its popliteal surface & oblique popliteal ligament of the knee joint
I: posterior calcaneus via calcaneal/achilles tendon
A: works with the gastrocnemius in plantar flexion of the ankle joint, assists with weak knee flexion
N: Tibial nerve (L4, L5, S1, S2)
Muscle Testing: Ankle Plantar Flexors: Gastrocnemius & Plantaris:
Patient: standing
Fixation: none
Test: rising on toes
Pressure: against weight of the body
Posterior Crural Muscle Group:
Soleus:
O: posterior surfaces of the head of the fibula & proximal 1/3 of its body, soleal line & middle 1/3 of the medial border of the tibia, and tendinous arch between the tibia and fibula
I: with the tendon of the gastrocnemius, into the posterior surface of the calcaneus
A: plantar flexes the ankle joint and weak inversion of the foot
N: Tibial nerve (L5, S1, S2)
Muscle Testing: Soleus:
Patient: prone, with knee flexed to 90 degrees
Fixation: examiner supports the leg proximal to the ankle
Test: plantar flexion of the ankle joint with no inversion or eversion of foot
Pressure: against the calcaneus, pulling the heel in a caudal direction
Posterior Crural Muscle Group
Popliteus:
O: anterior part of the groove on the lateral condyle of the femur & oblique popliteal ligament of the knee joint
I: triangular area proximal to the soleal line on the posterior surface of the tibia & fascia covering the muscle
A: non-weight bearing (fixed origin): medially rotates the tibia on the femur and flexes the knee joint
A: weight bearing (fixed insertion): laterally rotates the femur on the tibia and flexes the knee joint
N: Tibial nerve (L4, L5, S1)
Muscle Testing: Popliteus:
Patient: sitting with knee flexed
Fixation: none
Test: medial rotation of the tibia on the femur
Pressure: against the calcaneus, pulling the heel in a caudal direction
Posterior Crural Muscle Group - Deep
Tibialis Posterior:
O: most of the interosseous membrane, lateral portion of the posterior surface of the tibia, proximal 2/3 of the medial aspect of the fibula, adjacent intermuscular septa & deep fascia
I: tuberosity of the navicular bone and by fibrous expansions to the sustentaculum tali, three cuneiforms, cuboid & bases of the 2-4 metatarsal bones
A: inverts foot and assists in plantar flexion of the ankle joint
N: Tibial nerve (L4, L5, S1)
Muscle Testing: Tibialis Posterior:
Patient: supine with extremity in lateral rotation
Fixation: examiner supports the leg above the ankle joint
Test: inversion of the foot with plantar flexion of the ankle joint
Pressure: against the medial side of the plantar surface of the foot
Posterior Crural Muscle Group - Deep:
Flexor Digitorum Longus:
O: middle 3/5 of posterior surface of the body of the tibia & from fascia covering the tibialis posterior
I: bases of the distal phalanges of the 2nd through 5th digits
A: flexes proximal & distal interphalangeal and metatarsophalangeal joints of the 2-5 digits, assists in plantar flexion of the ankle joint and inversion of the foot
N: Tibial nerve (L5, S1, S2)
Note: this muscle is connected to the flexor hallucis longus muscle
Muscle Testing: Flexor Digitorum Longus:
Patient: supine or sitting
Fixation: examiner stabilizes the metatarsals and maintains a neutral position
Test: flexion of the distal interphalangeal joints of 2-5 digits
Pressure: against the plantar surface of the distal phalanges of 2-5 digits
Posterior Crural Muscle Group - Deep:
Flexor Hallucis Longus:
O: posterior surface of the distal 2/3 of the fibula, interosseous membrane, and adjacent intermuscular septa & fascia
I: base of the distal phalanx of the great toe, plantar surface
A: flexes the interphalangeal joint of the great toe, and assists in flexion of the metatarsophalangeal joint, plantar flexion of the ankle joint & inversion of the foot
N: Tibial nerve (L5, S1, S2)
Note: this muscle is connected to the flexor digitorum longus
Muscle Testing: Flexor Hallucis Longus:
Patient: supine or sitting
Fixation: examiner stabilizes the metatarsophalangeal joint in neutral
Test: flexion of the interphalangeal joint of the big toe
Pressure: against the plantar surface of the distal phalanx of the big toe
