Transcript Myology 肌学
Myology SHANDONG UNIVERSITY Liu Zhiyu Myology Morphology of skeletal muscle Muscle belly Tendon aponeurosis Classification Long muscle Short muscle Broad muscle Orbicular muscle Myology Origin －the fixed attachment Insertion － the movable attachment Action Agonist Antagonist Synergist Fixators Nomenclature of mucles : shape size Location their points of attachment Myology Accessory structures Fascia Superficial fascia Deep fascia Synovial bursa Myology Tendinous sheath Fibrous layer Synovial layer: Mesotendon vincula tendinum Synovial cyst of wrist Muscles of head Facial muscles Epicranius Frontal belly Occipital belly Galea aponeurotica Orbicularis oculi Buccinator Orbicularis oris Nasalis Facial muscles ★Masticatory muscles Temporalis Masseter lateral pterygoid Medial pterygoid ★ Masticatory muscles Temporalis Origin－temporal fossa Insertion－coronoid process of mandible Action－elevates and retracts mandible Masseter Origin－inferior border and medial surface of zygomatic arch Insertion－lateral surface of ramus of mandible and angle of mandible Action－elevates mandible ★ Masticatory muscles Lateral pterygoid Medial pterygoid Muscles of the neck Muscles of the neck Superficial group Platysma 颈阔肌 Sternocleidomastoid 胸锁乳突肌 Muscles of the neck Suprahyoid muscles Digastric Mylohyoid Stylohyoid Geniohyoid Elevate (raise) hyoid bone and depress mandible. Muscles of the neck Infrahyoid muscle Sternohyoid Sternothyroid Thyrohyoid Omohyoid Depress hyoid or larynx after elevation Muscles of the neck Deep group Lateral Scalenus anterior Scalenus medius Scalenus posterior Medial longus capitis longus colli Flex the head, bends the neck forward Major muscles of the neck ★ Sternocleidomastoid Origin: manubrium and sternal end of clavicle Insertion: mastoid process of temporal bone Action: contraction of one muscle draws head toward the same side, and turn face to opposite side; both muscles act together to draw head backward Major muscles of the neck Scalenus anterior Origin: transverse processes of C3-C6. Insertion: tubercle for scalenus anterior Action: unilateral, bends neck laterally; bilateral, elevate first rib, an accessory muscle of inspiration; if rib is fixed, flex neck anteriorly Major muscles of the neck ★ Scalene fissure Above the first rib, there is a triangular space between scalenus anterior and medius. The brachial plexus and the subclavine a. emerge from this space. Muscles of trunk The Muscles of Back Superficial group Trapezius Levator scapulae Rhomboideus Latissimus dorsi Thoracolumbar fascia The Muscles of Back Deep group Splenius Erector spinae Major Muscles of Back Trapezius Origin: superior nuchal line, external occipital protuberance, ligamentum nuchae and spinous processes of seventh cervical and all thoracic vertebrae Insertion: lateral third of clavicle, acromion, and spine of scapular Acton: upper fibers elevate scapula, lower fibers depress scapula; if scapula is fixed, one side acting along, draws head toward the same side, and turn face to opposite side; both sides together, draw head directly backward Nerve supply: accessory nerve (Ⅺ cranial nerve) Major Muscles of Back Latissimus dorsi Origin: Spinous processes of lower six thoracic and all lumbar vertebrae Median sacral crest Posterior part of iliac crest Insertion: floor of intertubercular groove of humerus. Action: trunk fixed, extends, adducts and medially rotates arm ; arm fixed, elevates trunk. Nerve supply: thoracodorsal nerve Thoracolumbar Fascia Anterior layer Middle layer Posterior layer Trapezius Levator scapular Deltoid Ausculatory triangle Rhomboideus Latissimus dorsi Inferior lumbar triangle Thoracolumbar fascia Muscles of thorax Muscles connecting the upper limb to the thoracic wall Pectoralis major Pectoralis minor Serratus anterior Muscles of thorax Intrinsic muscles Intercostales externi Intercostales interni Intercostales intimi Transverses thoracis Major muscles of thorax Pectoralis Major Origin: medial half of clavicle, sternum, upper six costal cartilages. Insertion: lateral lip of the bicipital groove of humerus Action: adducts the arm and rotates it medially; the clavicular fibers also flex the arm; with the arm above the head, raise the body as in climbing Nerve supply: lateral pectoral n. Major muscles of thorax Intercostales externi Origin: inferior border of rib above Insertion: superior border of rib below Replaced anteriorly by external intercostals membrane Action: raise ribs adding in forced inspiration Major muscles of thorax Intercostales interni Origin: superior border of rib below Insertion: inferior border of rib above Replaced posteriorly by internal intercostals membrane. Action: depress ribs for forced expiration Diaphragm Shape and position: dome-shaped between thorax and abdomen, consists of a peripheral muscular part and a central tendon Origin Sternal part: arising from xiphoid process Costal part: arising from lower six and costal cartilages Lumbar part: arising by two crura from upper 2-3 lumbar vertebrae Insertion: central tendon Weak areas: Lumbocostal triangle Sternocostal triangle Diaphragm Openings in the diaphragm Aortic hiatus lies anterior to the body of the 12th thoracic vertebra between the crura and transmits the aorta, thoracic duct Esophageal hiatus lies at level of T10. It transmits esophagus and vagus nerves Vena cava foramen lies at T8 level in the central tendon. It transmits the inferior vena cava. T8 T10 T12 Diaphragm Action: Contraction: the dome moving downward, increases the volume of thoracic cavity which results in inspiration, at the same time the intraabdominal pressure is increased assists in defecation, vomiting or child birth. Relaxation: the dome returns to the former position, reduces the volume to the thoracic cavity, resulting in expiration. Muscles of abdomen Anterolateral group Obliquus externus abdominis Obliquus internus abdominis Transversus abdominis Rectus abdominis Obliquus externus absominis General direction of fibers: downward, forward and medially (run down and inward) Obliquus externus absominis Structures Inguinal ligament Lacunar ligament Superficial inguinal ring － triangular-shaped defect in aponeurosis of obliquus externus abdominis above pubic tubercle Superficial inguinal ring Obliquus internus abdominis Deep to obliquus externus abdominis General direction of fibres: upwards, forwards and medially Transversus abdominis Deep to obliquus internus General direction of fibers: run horizontally forward. Transversus abdominis Inguinal falx Obliquus internus abdominis has a lower, free border that arches over spermatic cord Inserted with transversus abdominis fiber into medial part of pecten of pubis Cremaster Dirived from the lower fibers of the obliquus internus abdominis and transversus abdominis Around the spermatic cord and testis Rectus abdominis Position: lie on to either of midline Origin: pubic crest and symphysis Insertion: xiphoid and 5th7th costal cartilages Tendinous intersections 3-4 linea semiluaris Similar functions for above four pairs of muscles Support and compress the abdominal viscera Increase intra-abdominal pressure, aid in expulsive efforts-vomiting, coughing, sneezing, defecation, urination and childbirth. Depress ribs, assist in (the act of force(4)expiration. Flex, lateral flex, and rotate vertebral column Sheath of rectus abdominis Anterior layer Formed by fusion of aponeurosis of obliquus externus abdominis and anterior leaf of aponeurosis of obliquus internus abdominis Sheath of rectus abdominis Posterior layer Formed by fusion of posterion leaf of aponeurosis of obliquus internus abdominis and aponeurosis of transversus abdominis Absent in about 4-5cm below the umbilicus, where aponeuroses of all three muscles form anterior layer the lower free border named arcuate line Below this line rectus abdominis in contact with transverse fascia Muscles of abdomen Linea alba －tendinous raphe between right and left recti from xiphoid to pubic symphysis Landmarks and surface anatomy Linea alba Rectus abdominis Tendinous intersections Linea semilunaris Umbilicus: at the level of L3 ~ L4 Inguinal ligament Muscles of abdomen Posterior group Quadratus lumborum Psoas major Muscles of upper limb Muscles of shoulder Deltoid Supraspinatus Infraspinatus Teres minor Teres major Subscapularis Muscles of arm Antererior group Biceps brachii Coracobrachialis Brachialis Posterior group Triceps brachii Muscles of forearm Antererior group (9) Superficial layer (5) Brachioradialis Pronator teres Flexor carpi radialis Palmaris longus Flexor carpi ulnaris Muscles of forearm Antererior group (9) Second layer (1) Third layer (2) Flexor digitorum superficialis Flexor digitorum profundus Flexor pollicis longus Fourth layer (1) Pronator quadratus Action: flex radiocarpal joint and fingers, pronate forearm Muscles of forearm Posterior group (10) Superficial layer (5) Extensor carpi radialis longus Extensor carpi radialis brevis Extensor digitorum Extensor digiti minimi Extensor carpi ulnaris Muscles of forearm Posterior group (10) Deep layer (5) Supinator Abductor pollicis longus Extensor pollicis brevis Extensor pollicis longus Extensor indicis Action: extend radiocapral joint and fingers, and supinate forearm Muscles of hand Lateral group－thenar (4) Abductor pollicis brevis Flexor pollicis brevis Opponens pollicis Adductor pollicis Action: flex, abduct, adduct and oppose thumb Medial group－hypothenar 小鱼际（3） Abductor digiti minimi Flexor digiti minimi brevis Opponens digiti minimi Action: flex, abduct , and oppose little finger Muscles of hand Intermedial group Lumbricales (4) flex fingers at MP joints; extend fingers at IP joints Palmar interossei (3) adduct fingers towards middle finger at MP joints Dorsal interossei (4) abduct fingers away from middle finger at MP joints Major muscles of upper limb Deltoid Origin: lateral third of clavicle, acromion, and spine of scapula Insertion: deltoid tuberosity of humerus Action: abducts the arm， anterior fibers flex and medially rotate arm; posterior fibers extend and laterally rotate arm Major muscles of upper limb Teres major Origin: dorsal surface of inferior angle of scapula Insertion: crest of lesser tubercle of humerus Action: medially rotates and adducts arm Major muscles of upper limb Trilateral and quadrilateral foramina Between the subscapularis and teres major, there is a long triangular space whose lateral side is surgical neck of humerus. The long head of triceps brachii subdivides this space into a medial trilateral foramen and a lateral quadrilateral foramen. Major muscles of upper limb Biceps brachii Origin: long head, supraglenoid tubercle; short head, coracoid process Insertion: radical tuberosity Action: supinator of forearm, flexor of elbow joint, weak flexor of should joint Nerve supply: Musculocutaneous n. Major muscles of upper limb Triceps brachii Origin: long head, infraglenoid tubercle; lateral head, above groove for radical n., medical head, below groove for radical n. Insertion: olecranon of ulna Action: extends elbow joint, long head can extend and adduct shoulder joint Major muscles of upper limb Pronator teres Origin: medical epicondyle of humerus and deep fascia of forearm Insertion: middle of lateral surface of radius Action: pronation of forearm and flexion of elbow Nerve supply: median n. Major muscles of upper limb Supinator Origin: lateral epicondyle of humerus and upper part of lateral border of ulna Insertion: upper third of anterior surface of radius Action: supination of forearm Muscles of lower limb Muscles of lower limb The muscles of lower limb are divided into: Muscles of hip Muscles of thigh Muscles of leg Muscles of foot Muscles of hip Anterior group Iliopsoas Iliacus Psoas major Psoas minor Tensor fasciae latae Muscles of hip Posterior group Gluteus maximus Gluteus medius Gluteus minimus Piriformis Obturator internus Obturator externus Quadratus femoris Muscles of thigh Anterior group Sartorius Quadricep Rectus femoris Vastus lateralis Vastus intermedius Vastus medialis Blood supply: femoral artery Nerve supply: femoral nerve Muscles of thigh Medial group Pectineus Adductor longus Adductor brevis Adductor magnus Gracilis Action: adduct thigh at hip joint Blood supply: Deep femoral a. Obturator a. Nerves supply: obturator n. Muscles of thigh Posterior group Biceps femoris Semitendinosus Semimembranosus Action Flex the leg at knee joint Extend the thigh at hip joint Muscles of leg Anterior group Tibialis anterior Extensor hallucis longus Extensor digitorum longus Peroneus tertius Blood supply: Anterior tibial a. Nerve supply: Deep peroneal n. Muscles of leg Lateral group Peroneus longus Peroneus brevis Action: plantar flex and evert the foot Blood supply: branches from the peroneal artey Nerve supply: superficial peroneal n. Muscles of leg Posterior group Superficial lager triceps surae Gastrocnemius Soleus Muscles of leg Posterior group Deep layer Popliteus Flexor digitorum longus Tibialis posterior Flexor hallucis longus Nerve supply: tibial n. Muscles of foot Muscles on dorsum: extensor digitorum brevis Muscles in sole: medial, lateral and intermediate groups Muscles of hip Iliopsoas Origin: Psoas major: transverse processes and lateral surface of bodies of lumbar vertebrae Iliacus: iliac fossa Insertion: lesser trochanter of femur Action: flexes thigh on trunk Nerve supply: lumbar plexus Muscles of hip Gluteus maximus Origin: gluteal surface of ilium and dorsal aspect of sacrum Insertion: gluteal tuberosity of femur and iliotibial tract Action: extends and laterally rotates thigh at hip joint; raises trunk when the lower limb is fixed Nerve supply: inferior gluteal n. Muscles of thigh Sartorius Origin: anterior superior iliac spine Insertion: upper medial surface of tibia Action: flexes hip and knee joints; rotates flexed knee medially Nerve supply: femoral n. Muscles of thigh Quadriceps femoris Origin: Rectus femoris: anterior inferior iliac spine Vastus medialis: medial lip of linea aspera Vastus lateralis: lateral lip of linea aspera Vastus intermedius: anterior surface of femur Insertion: tibial tuberosity via patellar ligament Action: extends leg at knee joint; rectus femoris also flexes thigh at hip joint Nerve supply: femoral n. Muscles of leg Tibialis anterior Origin: lateral surface of tibia Insertion: medial cuneiform and base of 1st metatarsal Action: dorsiflexes and inverts foot Nerve supply: deep peroneal n. Muscles of leg Triceps surae Origin: Gastrocnemius: medial and lateral condyles of femur Soleus: soleal line of tibia and upper third of fibula Insertion: calcaneum via tendo calcaneus Action: flexes knee joint and plantar flexes foot at ankle joint; steadies leg on foot during standing Nerve supply: tibial n. Muscles of leg Tibialis posterior Origin: posterior surface of tibia and fibula and interosseous membrane Insertion: tuberosity of navicular, all cuniforms Action: plantar flexes and inverts foot Nerve supply: tibial n.