Test 3 Muscle AXNs, Attachments, Nerves Flashcards
pelvic splanchnic nn origin
S2, S3, S4 ventral rami
lumbar splanchnic nn origin
T1-L2
innervation of ureters: parasympathetic or sympathetic?
both sympathetic and parasympathetic
innervation of ureters: sympathetic
what TYPE of info and where does it go?
what is the referred pain pattern?
afferent pain info and sensory stretch, goes back towards T11-L2
referred pain: ipsilateral along subcostal, ilioinguinal, and genitofemoral nn distribution
innervation of ureters: parasympathetic
what is under parasympathetic control and what is the origin?
vagus n and S2, S3, S4 ventral rami
motor: contraction and peristaltic motion of ureters
external urethral sphincter
somatic efferents (motor) pudendal n, S2, S3, S4 ventral rami
bladder
parasympathetic fibers (pelvic splanchnic nn S2, S3, S4) sympathetic fibers (hypogastric plexus through T11-L2 regions of spinal cord)
what neural message(s) do the pelvic splanchnic nn to the bladder carry?
- visceral afferent (sensory to detrusor muscle to determine level of stretch and relays PAIN from lower bladder)
- motor (to detrusor muscles – causes smooth muscle wall of bladder to contract)
- inhibition (to internal sphincter – relaxes and urine can flow)
urethra
EUS is under voluntary control (pudendal n S2, S3, S4)
sensory afferents run in pelvic splanchnic nn (parasympathetic)
internal urethral sphincter: sympathetic or parasympathetic?
both sympathetic and parasympathetic
internal urethral sphincter: sympathetic function and levels
T10-L2
keeps it contracted
internal urethral sphincter: parasympathetic function and levels
S2, S3, S4
inhibits, so IUS can relax
vagina
sympathetics via L1/L2
parasympathetics, S2, S3, S4 via pelvic splanchnic
what does the pudendal n innervate?
is S2, S3, S4
somatic motor supply to skeletal muscles:
- external anal sphincter
- external urethral sphincter
afferent supply to skin of perineal region
external anal sphincter
S4 ventral ramus (voluntary control)
internal anal sphincter
supplied by sympathetic and parasympathetic fibers to maintain or inhibit tone (respectively)
gluteus maximus proximal attachment
posterior ilium to posterior gluteal line
dorsal surface of sacrum and coccyx
sacrotuberous ligament
gluteus maximus distal attachment
iliotibial tract
some fibers to gluteal tuberosity of femur
gluteus maximus action
hip extension; extension of trunk when LEs are fixed
assists with ER/ LR of thigh
gluteus maximus innervation
inferior gluteal n (L5, S1, S2)
where does the iliotibial tract insert?
lateral tibial condyle
gluteus medius proximal attachment
external surface of ilium (between anterior and posterior gluteal lines)
gluteus medius distal attachment
lateral surface of greater trochanter of femur
gluteus medius action
anterior and posterior fibers: abduct thigh abduction of pelvis levels pelvis when opposite leg is raised anterior fibers: internal rotation posterior fibers: external rotation
gluteus medius innervation
superior gluteal n (L4, L5, S1)
gluteus minimus proximal attachment
external surface of ilium between anterior and inferior gluteal lines
gluteus minimus distal attachment
anterior surface of greater trochanter of femur
gluteus minimus action
abduct hip
IR hip
abduct pelvis
gluteus minimus innervation
superior gluteal n (L4, L5, S1)
piriformis proximal attachment
anterior surface of sacrum
sacrotuberous ligament
(exits greater sciatic foramen)
piriformis distal attachment
superior border of greater trochanter of femur
piriformis action
ER of extended/ neutral femur
ABD flexed hip
steadies femoral head in acetabulum
piriformis innervation
N. to piriformis (S1*, S2)
obturator internus proximal attachment
pelvic surface of obturator membrane and surrounding pelvis bones
obturator internus distal attachment
medial surface of greater trochanter of femur trochanteric fossa (also blends with gemelli mm here)
obturator internus action
ER extended femur
ABD flexed thigh
steadies femoral head
obturator internus innervation
n to obturator internus and superior gemellus (L5, S1*)
superior gemellus proximal attachment
ischial spine
superior gemellus distal attachment
medial surface of greater trochanter, trochanteric fossa
superior gemellus action
ER extended thigh
ABD flexed thigh
steadies femur
superior gemellus innervation
n. to obturator internus and superior gemellus (L5, S1*)
inferior gemellus proximal attachment
ischial tuberosity
inferior gemellus distal attachment
medial surface of greater trochanter, trochanteric fossa
inferior gemellus action
ER extended thigh
ABD flexed thigh
steadies femur
inferior gemellus innervation
n. to quadratus femoris and inferior Gemellus (L5, S1)
quadratus femoris proximal attachment
lateral border of ischial tuberosity
quadratus femoris distal attachment
quadrate tubercle on intertrochanteric crest of femur (+ just inferior to it)
quadratus femoris action
ER of thigh
steadies femoral head
quadratus femoris innervation
n to quadratus femoris and inferior Gemellus (L5 ,S1)
obturator externus proximal attachment
margins of obturator foramen and obturator membrane
obturator externus distal attachment
trochanteric fossa of femur
obturator externus action
ER hip
steadies head of femur
obturator externus innervation
obturator n (posterior division) L3, L4*
semitendinosus proximal attachment
ischial tuberosity
semitendinosus distal attachment
medial surface of superior tibia (per anserine, sgT)
SGT = sergeant or “say grace before tea”
semitendinosus action
extend hip
flex knee
IR hip
extend trunk if in closed kinematic chain
semitendinosus innervation
tibial portion of sciatic n (L5, S1, S2)
semimembranosus proximal attachment
ischial tuberosity
semimembranosus distal attachment
posterior part of medial tibial condyle
reflected attachment to oblique popliteal ligament (semimembranosus and oblique popliteal ligament = SMOP)
semimembranosus action
extend hip
flex knee
IR hip
extend trunk if in closed kinematic chain
semimembranosus innervation
tibial portion of sciatic n (L5, S1, S2)
biceps femoris long head proximal attachment
ischial tuberosity
biceps femoris long head distal attachment
lateral head of fibula
biceps femoris long head action
extend hip
flex knee
ER hip
biceps femoris long head innervation
tibial portion of sciatic n (L5, S1, S2)
biceps femoris short head proximal attachment
linea aspera
lateral supracondylar line of femur
biceps femoris short head distal attachment
lateral head of fibula
biceps femoris short head action
flex knee
ER hip
biceps femoris short head innervation
common (fibular) peroneal portion of sciatic n (L5 ,S1*, S2)
plantaris proximal attachment
inferior end of lateral supracondylar line of femur
oblique popliteal ligament
plantaris distal attachment
posterior surface of calcaneus via calcaneal tendon
what does the posterior femoral cutaneous nerve innervate?
skin overlying popliteal fossa
pectineus proximal attachment
superior ramus of pubis
pectineus distal attachment
pectineal line of femur, inferior to lesser trochanter
pectineus action
adduct hip
flex hip
assist with IR of hip
pectineus innervation
femoral n (L2*, L3) sometimes branch from obturator n
psoas major proximal attachment
lateral aspect of T12-L5 + discs
transverse processes of all lumbar vertebrae
psoas major distal attachment
lesser trochanter of femur
psoas major action
flex hip
stabilize hip joint (with psoas minor and iliacus)
psoas major innervation CHECKKKKKKK
L1, L2, L3 ventral rami
psoas minor proximal attachment
lateral aspect of T12-L1 + discs
psoas minor distal attachment
iliopectineal eminence
psoas minor action
** with psoas major and iliacus
flexes hip
stabilizes hip joint
psoas minor innervation
L1, L2 ventral rami
tensor fascia lata (TFL) proximal attachment
ASIS
anterior part of iliac crest
tensor fascia lata (TFL) distal attachment
iliotibial band (which then attaches to lateral tibial condyle at Gerdy’s tubercle)
tensor fascia lata (TFL) action
abducts hip IR hip flexes hip caveats: - helps support femur on tibia while standing - may be secondary knee flexor once knee is flexed >30 degrees - may assist with knee extension - steadies trunk on thigh
tensor fascia lata (TFL) innervation
superior gluteal nerve (L4, L5, S1)
sartorius proximal attachment
ASIS
superior part of notch
sartorius distal attachment
superior part of medial surface of tibia (pes anserine)
sartorius action
flex hip abduct hip ER hip flex knee IR of tibia on femur considered secondary muscles, assisting all other muscles helping with tailor sit
sartorius innervation
femoral n (L2, L3)
quadriceps femoris muscles (superficial and deep, and which is 2 joint)
superficial: - rectus femoris (2 joint) - vastus lataralis - vastus medialis deep: - vastus intermedius
rectus femoris proximal attachment
AIIS
ilium, superior to acetabulum
rectus femoris distal attachment
base of patella via quadriceps tendon and by the patellar ligament to tibial tuberosity
rectus femoris action
extend leg at knee joint
flex hip
rectus femoris innervation
femoral n (L2, L3, L4)
vastus lateralis proximal attachment
greater trochanter
lateral lip of linea aspera of femur
lateral intermuscular septum
vastus lateralis distal attachment
base of patella via quadriceps tendon and by the patellar ligament to tibial tuberosity
vastus lateralis action
extend leg at knee joint
vastus lateralis innervation
femoral n (L2, L3, L4)
vastus medialis proximal attachment
intertrochanteric line
medial lip of linea aspera of femur
vastus medialis distal attachment
base of patella via quadriceps tendon and by the patellar ligament to tibial tuberosity
vastus medialis action
extend leg at knee joint
vastus medialis innervation
femoral n (L2, L3, L4)
vastus intermedius proximal attachment
anterior and lateral surfaces of body of femur
vastus intermedius distal attachment
base of patella via quadriceps tendon and by the patellar ligament to tibial tuberosity
vastus intermedius action
extend leg at knee joint
vastus intermedius innervation
femoral n (L2, L3, L4)
saphenous nerve provides innervation to…
sensory innervation to anteriomedial, medial, and posteriomedial surface of leg
passes through adductor canal and supplies medial leg
adductor longus proximal attachment
body of pubis, inferior to pubic crest
adductor longus distal attachment
middle third of linea aspera of femur
adductor longus action
adduction of hip/ thigh
adductor longus innervation
anterior branch of obturator n (L2, L3*, L4)
adductor brevis proximal attachment
body and inferior ramus of pubis
adductor brevis distal attachment
pectineal line
proximal part of linea aspera of femur
adductor brevis action
adduction of hip
assist with hip flexion
adductor brevis innervation
anterior branch of obturator nerve (L2, L3*, L4)
adductor magnus adductor portion proximal attachment
inferior ramus of pubis
ramus of ischium
adductor magnus adductor portion distal attachment
gluteal tuberosity
linea aspera
medial supracondylar line
adductor magnus adductor portion action
adduct thigh
flex thigh
adductor magnus adductor portion innervation
posterior branch of obturator nerve (L2, L3, L4)
adductor magnus hamstring portion proximal attachment
ischial tuberosity
adductor magnus hamstring portion distal attachment
adductor tubercle of femur
adductor magnus hamstring portion action
adduct thigh
extend thigh
adductor magnus hamstring portion innervation
tibial portion of sciatic nerve (L4*)
gracilis proximal attachment
body and inferior ramus of pubis
gracilis distal attachment
superior part of medial surface of tibia (pes anserinus)
gracilis action
adduct hip
flex knee
assist with IR of tibia at knee
gracilis innervation
anterior branch of obturator n
tibialis anterior proximal attachment
lateral condyle
superior half of lateral surface of tibia
interosseous membrane
tibialis anterior distal attachment
medial and inferior surface of medial cuneiform
based of 1st metatarsal
tibialis anterior action
strong dorsiflexor of ankle
weak investor of foot
tibialis anterior innervation
deep peroneal n (L4*, L5)
extensor hallucis longus proximal attachment
middle part of anterior surface of fibula and interosseous membrane
extensor hallucis longus distal attachment
dorsal aspect of base of distal phalanx of great toe
extensor hallucis longus action
extends great toe
DF ankle
invert foot
extensor hallucis longus innervation
deep peroneal n (L4*, L5, S1) – can vary
extensor digitorum longus proximal attachment
lateral condyle of tibia
proximal 3/4 medial surface of fibula and interosseous membrane
extensor digitorum longus distal attachment
base of middle and distal phalanges of lateral 4 toes
extensor digitorum longus action
** extend lateral 4 digits
DF ankle
weak everter of foot
extensor digitorum longus innervation
deep peroneal n (L4*, L5, S1)
peroneus tertius proximal attachment
inferior 1/3 of anterior surface of fibula and interosseous membrane
peroneus tertius distal attachment
dorsum of base of 5th metatarsal
peroneus tertius action
DF ankle
assist with eversion of foot
peroneus tertius innervation
deep peroneal n (L4*, L5, S1)
peroneus longus proximal attachment
head and proximal 2/3 of lateral surface of fibula
peroneus longus distal attachment
base of 1st metatarsal and medial cuneiform
peroneus longus action
eversion of foot
PF of ankle
depresses base of 1st metatarsal
peroneus longus innervation
superficial peroneal nerve (L5, S1, S2)
gastrocnemius proximal attachment - lateral head
lateral aspect of lateral condyle of femur
gastrocnemius proximal attachment - medial head
from popliteal surface of femur, superior to medial condyle
gastrocnemius distal attachment
posterior surface of calcaneus via calcaneal (Achilles) tendon
gastrocnemius action
PF ankle** (primary)
foot inverter
flex knee joint (assists – if short, can limit knee extension)
supports end range of foot inversion and eversion (bc of how wide Achilles tendon is)
gastrocnemius innervation
tibial n (S1, S2)
soleus proximal attachment
posterior aspect of head of fibula
superior 1/4 of posterior surface of fibula
soleal line of tibia
medial border of tibia
soleus distal attachment
posterior surface of calcaneus via cancaneal tendon
soleus action
PF ankle (regardless of knee position) inversion of ankle
soleus innervation
tibial n (S1, S2)
plantaris proximal attachment
inferior end of lateral supracondylar line of femur and oblique popliteal ligament
plantaris proximal attachment
posterior surface of calcaneus via calcaneal tendon
plantaris action
knee flexion
weak assist in PF of ankle
plantaris action
tibial n (S1, S2)
ventral rami: tibial n
L4-S3
ventral rami: common peroneal n
L4-S2
popliteus proximal attachment
lateral surface of lateral condyle of femur and lateral meniscus**
popliteus distal attachmnet
posterior surface of tibia, superior to soleal line
popliteus action and function
action: weakly flex knee IR tibia on femur (unlocks knee) function: forms part of floor of popliteal fossa
flexor digitorum longus proximal attachment
medial part of posterior surface of tibia, inferior to soleal line
flexor digitorum longus distal attachment
base of distal phalanges of lateral 4 toes
flexor digitorum longus action
flex lateral 4 digits
PF ankle
inversion of foot
supports longitudinal arch of foot
flexor digitorum longus innervation
Tibial n (S2, S3)
intrinsic foot muscles that attach to flexor digitorum longus
quadratus plantae inserts on FDL
lumbricals arise from FDL
flexor hallicus longus proximal attachment
inferior 2/3 of posterior surface of fibula
inferior part of interosseous membrane
flexor hallicus longus distal attachment
plantar surface, base of distal phalanx of great toe
flexor hallicus longus action
flex great toe PF ankle inversion of foot supports medial long arch (powerful push-off muscle during walking)
flexor hallicus longus innervation
tibial n (S2, S3)
tibialis posterior proximal attachment
interosseous membrane
posterior surface of tibia inferior to soleal line
posterior surface of fibula
tibialis posterior distal attachment
tuberosity of navicular all cuneiform bones sustentaculum tali cuboid base of 2nd, 3rd, and 4th metatarsals (aka all tarsal bones except talus)
tibialis posterior action
main investor of foot
PF ankle
resist collapse of arch
tibialis posterior innervation
tibial n (L4, L5)
extensor digitorum brevis proximal attachment
floor of sinus tarsi of calcaneus and extensor retinaculum
extensor digitorum brevis distal attachment
medial 4 toes
CHECK
extensor digitorum brevis action
aids EDL in extending medial 4 toes at MTP joints
CHECK
extensor digitorum brevis innervation
deep peroneal n
extensor hallucis brevis proximal attachment
floor of sinus tarsi of calcaneus and extensor retinaculum
extensor hallucis brevis distal attachment
dorsal aspect of base of proximal phalanx of great toe
extensor hallucis brevis action
aids EHL in extending great toe at MTP
extensor hallucis brevis innervation
deep peroneal n
terminal cutaneous branch of deep peroneal n innervates…
sensation to 1st web space
medial and lateral plantar nn are terminal branches of…
tibial n
abductor hallucis is in layer _ of intrinsic foot muscles and is innervated by ___
1
medial plantar n
lumbricals are in layer _ of intrinsic foot muscles and are innervated by ___
2
lateral 3: lateral plantar n
1st: medial plantar n
quadratus plantae is in layer _ of intrinsic foot muscles and is innervated by ___
2
lateral plantar n
flexor hallucis brevis is in layer _ of intrinsic foot muscles and is innervated by ___
3
medial plantar n
adductor hallucis is in layer _ of intrinsic foot muscles and is innervated by ___
3
lateral plantar n
if there is a lesion to the lateral plantar n, will the motor supply to the big toe be impacted?
no
flexor digitorum brevis is in layer _ of intrinsic foot muscles and is innervated by ___
1
medial plantar n
plantar interossei are in layer _ of intrinsic foot muscles and is innervated by ___
4
lateral plantar n
flexor digiti minimi is in layer _ of intrinsic foot muscles and is innervated by ___
3
lateral plantar n
action of quadratus plantae
assists in flexing lateral 4 digits
abductor digiti minimi is in layer _ of intrinsic foot muscles and is innervated by ___
1
lateral plantar n
dorsal interossei are in layer _ of intrinsic foot muscles and are innervated by ___
4
lateral plantar n
medial plantar n cutaneous innervation of foot
dorsal foot, medial to 4th metatarsal and inferior to calcaneus
saphenous n cutaneous innervation of foot
skin on medial side of ankle and foot up to head of 1st metatarsal
calcaneal branch of tibial n cutaneous innervation of foot
dorsal foot, over calcaneus
lateral plantar n cuteanous innervation of foot
dorsal foot, lateral to 4th metatarsal and inferior to calcaneus
sural n cuteanous innervation of foot
dorsal foot, most lateral (along lateral edge)
saphenous n originates from…
femoral n
sural n originates from…
med/lat sural from tibial and common fibular
tibial n originates from…
sciatic n
superficial fibular (peroneal) n originates from…
common fibular/ peroneal n
deep fibular (peroneal) n originates from…
common fibular/ peroneal n
lateral plantar n originates from…
tibial n
medial plantar n originates from…
tibial n