Muscle Origin Insertion Innervation Function. Iliotibial tract of fascia latae. Medial surface of the tibia just inferomedial to the tibial tuberosity

Transcription

1 KinetaCore Functional Dry Needling Level I Muscle Chart Listed below are the muscles you will be expected to treat in FDN Level 1. Use this chart as a guide to focus on attachments, segments of innervation, and the functional role of each muscle. Begin to think about the muscles in three dimensions. Understand that variations may be found across different resources. The information herein is adapted from: Davies, D. V., & Davies, F. (Eds.). (1962). Gray s anatomy: Descriptive and Applied. Longmans. Drake, R.L., Vogl, A.W., Mitchell, A.W.M. (2010). Gray s Anatomy for Students. Churchill Livingstone. ANTERIOR HIP AND THIGH Tensor Fascia Latae Lateral aspect of crest of ilium between anterior superior iliac spine and tubercle of the crest Iliotibial tract of fascia latae L4-L5-S1 Superior gluteal Assists in flexion, abduction and medial rotation of the hip. Assists with knee extension and stabilizes the knee in extension. Sartorius Anterior superior iliac spine Medial surface of the tibia just inferomedial to the tibial tuberosity L2-L3 Femoral Sartorius is a weak flexor and lateral rotator and assists in abduction of the hip. It also flexes the knee and medially rotates the leg when the knee is flexed. Rectus Femoris Straight head originates from the anterior inferior iliac spine; reflected tendon originates from the ilium just superior to the acetabulum Quadriceps femoris tendon L2-L3-L4 Femoral Flexes the thigh at the hip and extends the leg at the knee

2 Vastus Lateralis Femur - lateral part of intertrochanteric line, margin of greater trochanter, lateral margin of gluteal tuberosity, lateral lip of the linea aspera Quadriceps femoris tendon of femur and lateral margin of patella L2-L3-L4 Femoral Extends the leg at the knee Vastus Intermedius Femur - upper 2/3rds of anterior and lateral surfaces Quadriceps femoris tendon L2-L3-L4 Femoral Extends the leg at the knee Vastus Medialis Femur- medial part of intertrochanteric line, pectineal line, medial lip of the linea aspera, medial supracondylar line. Quadriceps femoris tendon and medial border of the patella L2-L3-L4 Femoral Extends the leg at the knee MEDIAL AND POSTERIOR THIGH Adductor Longus External surface of body of pubis (triangular depression inferior to the pubic crest and lateral to pubic symphysis) Linea aspera on middle one third of shaft of femur L2-L3-L4 Obturator (anterior division) Adducts and medially rotates thigh at hip

3 Gracilis A line on the external surfaces of the body of the pubis, the inferior pubic ramus and the ramus of the ischium Medial surface of the proximal shaft of tibia L2 - L3 Obturator Adducts thigh at hip and flexes leg at knee Adductor Magnus Adductor Portion Ischiopubic ramus Posterior surface of proximal femur, linea aspera, medial supracondylar line L2-L3-L4 Obturator Adducts and medially rotates thigh at hip Hamstring Portion Ischial tuberosity Adductor tubercle and supracondylar line L4-S1 Sciatic (tibial division) Adducts and medially rotates thigh at hip Semimembranosus Superolateral impression on the ischial tuberosity Medial surface of proximal tibia L5-S1-S2 Sciatic Flexes leg at knee and extends thigh at hip medially rotates thigh at hip and leg at knee Semitendinosus Inferomedial part of the upper area of the ischial tuberosity Medial surface of proximal tibia L5-S1-S2 Sciatic Flexes leg at knee and extends thigh at hip medially rotates thigh at hip and leg at knee Biceps Femoris Long head- inferomedial part of the upper part of ischial tuberosity Short head - lateral lip of linea aspera Head of fibula Long head L5-S1-S2 Sciatic (tibial) Short head L5-S1-S2 Sciatic (fibular) Flexes and laterally rotates leg at knee. Extends and laterally rotates the thigh at hip.

4 POSTERIOR HIP Muscle Origin Insertion Innervation Actions Gluteus Maximus Fascia covering gluteus medius, external surface of the ilium behind the posterior gluteal line, fascia of the erector spinae, dorsal surface of the lower sacrum, lateral margin of coccyx, external surface of sacrotuberous ligament Posterior aspect of the iliotibial tract of tensor fascia latae and gluteal tuberosity of proximal femur L5-S1-S2 Inferior gluteal Powerful extensor of flexed femur at the hip ; lateral stabilizer of the hip and knee ; laterally rotates and abducts thigh Gluteus Medius External surface of the ilium between anterior and posterior gluteal lines Elongate facet on the lateral surface of the greater trochanter L4-L5-S1 Superior gluteal Abducts femur at the hip, holds pelvis secure over stance leg preventing pelvic drop with gait; medially rotates thigh Gluteus Minimus External surface of the ilium between inferior and anterior gluteal lines Linear facet on the anterolateral aspect of the greater trochanter L4-L5-S1 Superior gluteal Abducts femur at the hip, holds pelvis secure over stance leg preventing pelvic drop with gait; medially rotates thigh Piriformis Anterior surface of the sacrum between anterior sacral foramina Medial side of the superior border of greater trochanter of femur Branches of L5- S1-S2 Laterally rotates the extended femur at hip, abducts flexed femur at hip

5 LUMBAR SPINE Multifidus Sacrum, origin of erector spinae, posterior superior iliac spine, mammillary processes of lumbar vertebrae, transverse processes of thoracic vertebrae and articular processes of lower four cervical vertebrae Base of spinous processes of all vertebrae from L5 - C2 Medial branch of the dorsal rami of segmental spinal s Stabilizes vertebrae in local movements of the vertebral column. Global movements Contract bilaterally to extend the vertebral column Contract unilaterally to produce rotation in opposite direction Erector spinae muscles Arise from a broad thick tendon attached to the sacrum, spinous processes of the lumbar and lower thoracic vertebrae and iliac crest Divide in the upper lumbar region into three vertical columns of muscle, each which is divided regionally depending on its superior attachments Segmental Primary extensors of the vertebral column and head. Acting bilaterally they straighten the back - returning it upright from a flexed position Longissimus Thoracis Accessory processes and adjacent medial end of the dorsal surface of the transverse processes of lumbar vertebrae, ilium Apices of the transverse processes of T1 to T12 and the fourth to twelfth ribs between the tubercle and angle Segmental Iliocostalis lumborum Sacrum, spinous processes of lumbar and lower two thoracic vertebrae and their supraspinous ligaments, and the iliac crest Angles of the lower six or seven ribs Segmental

6 CERVICAL SPINE Upper Trapezius Superior nuchal line, external occipital protuberance, medial margin of the ligamentum nuchae, spinous process of C2-7 Lateral one-third of the clavicle and to the acromion Motor - spinal part of the accessory Sensory - anterior rami of C3 and C4 Elevates the scapula and assists in upward rotation of the scapula during abduction of the humerus above horizontal Deep Cervical Multifidus Articular process of C4- C7 Base of spinous process of all vertebrae to C2 Medial branch of dorsal rami Stabilizes vertebrae in local movements of the vertebral column. Global movements - Bilaterally contract to extend the vertebral column Unilaterally contract to produce rotation in opposite direction Superficial Cervical Erector Spinae (know general muscles and anatomy - specific muscles are listed below for reference) Spinous processes as low as T6-7, angles of the ribs, ligamentum nuchae Mastoid process, occiput below superior nuchal line, transverse processes Segmental Extend cervical spine and head, rotate cervical spine. Splenius Capitis Lower half of ligamentum nuchae, spinous processes of C7 to T4 Mastoid process, skull below lateral one third of the superior nuchal line Posterior rami of middle cervical s Together draw head backward extending neck; individually rotate to same side

7 Splenius Cervicis Spinous processes of T3- T6 Transverse processes of C1-3 Posterior rami of lower cervical s Together: extend neck Individually: draw and rotate head to same side. Iliocostalis Cervicis (most lateral column) Angles of ribs 3-6 Transverse processes of C4-6 Medial branch of the posterior rami of segmental spinal s The erector spinae act together as the primary extensors of the vertebral column and head Acting together they straighten the back, returning it to neutral from a flexed position Unilaterally they bend the vertebral column laterally Longissimus Cervicis (intermediate column) Transverse process of upper four or five vertebrae Transverse process of C2-6 Largest subdivision Spinalis Cervicis (medial column) Spinalis Capitis Lower part of ligamentum nuchae and spinous processes of C2 (sometimes T1 or T2) Usually blends with semispinalis capitis Spinous process of C2 Usually blends with semispinalis capitis Smallest of the subdivisions Interconnects the spinous process of adjacent vertebrae. Most constant in thoracic region, can be absent in cervical region where it is associated with the deeper sempispinalis capitis

8 Semispinalis Cervicis Transverse processes of upper five or six thoracic vertebrae Spinous process of C2-C5 Bilaterally: extend the vertebral column; Individually: turn or rotate in opposite direction Semispinalis Capitis Transverse processes of T1- T6 and C7 articular process of C4-6 Medial area between the superior and inferior nuchal lines of the occipital bone Bilaterally: pulls the head posteriorly; Individually: pulls head posteriorly and turns it SHOULDER Infraspinatus Medial 2/3rds of infraspinous fossa of the scapula Middle facet on posterior surface of the greater tubercle of the humerus C5-C6 Suprascapular Rotator Cuff muscle: Lateral rotation of the arm at the glenohumeral Teres Minor Upper 2/3rds of flattened bone on posterior surface of of the scapula immediately adjacent to the lateral border of the scapula Inferior facet on the posterior surface of the greater tubercle of the humerus C5 - C6 Axillary Rotator Cuff muscle: Lateral rotation of the arm at the glenohumeral Teres Major Elongate oval area on the posterior surface of the inferior angle of the scapula Medial lip of the intertubercular sulcus on the anterior surface of the humerus C5-C6-C7 Inferior subscapular Medial rotation and extension of the arm at the glenohumeral

9 Latissimus Dorsi Spinous processes of lower six thoracic vertebrae and related interspinous ligaments; via the thoracolumbar fascia to the spinous processes of the lumbar vertebrae, related interspinous ligaments, and iliac crest; lower 3-4 ribs Floor of intertubercular sulcus C6 - C7- C8 Thoracodorsal Adduction, medial rotation, and extension of the arm at the glenohumeral Deltoid Inferior edge of the crest of the spine of the scapula, lateral margin of the acromion, anterior border of lateral one-third of clavicle. Deltoid tuberosity of the humerus C5-C6 Axillary Major abductor of arm, clavicular fibers assist in flexing the arm; posterior fibers assist in extending the arm Pectoralis Major Clavicular head Anterior surface of the medial half of the clavicle Sterno-costal head Lateral lip of intertubercular sulcus of humerus C5 - C6 medial and lateral pectoral s Flexion, adduction and medial rotation of arm at glenohumeral. Clavicular Head: Flexion of the extended arm Anterior surface of the sternum; first seven costal cartilages; aponeurosis of external oblique Lateral lip of C6 - C7- C8 - T1 intertubercular sulcus of humerus Sterno-costal head: extension of flexed arm

10 LOWER EXTREMITY Gastrocnemius Medial head: posterior surface of distal femur just superior to medial condyle; Lateral head: upper posterolateral surface of lateral femoral condyle Via calcaneal tendon, to posterior surface of calcaneus S1 - S2 Tibial Plantarflexes foot and flexes knee Soleus Soleal line and medial border of tibia; posterior aspect of fibula head and adjacent surfaces of neck and proximal shaft; tendinous arch between tibial and fibular attachments Via calcaneal tendon, to posterior surface of calcaneus S1 - S2 Tibial Plantarflexes the foot Anterior Tibialis Lateral surface of the tibia and adjacent interosseous membrane Medial and inferior surfaces of medial cuneiform and adjacent surfaces on base of first metatarsal L4 - L5 Deep fibular Dorsiflexion of foot and ankle ; inversion of foot; dynamic support of medial arch of foot Extensor Digitorum Longus Proximal one-half of medial surface of fibula and related surface of lateral tibial condyle Via dorsal digital expansions into bases of distal and middle phalanges of lateral four toes L5-S1 Deep fibular Extension of lateral four toes and dorsiflexion of foot Fibularis Longus Upper lateral surface of the fibula, head of fibula, and occasionally the lateral tibial condyle Undersurface of lateral sides of distal end of medial cuneiform and base of first metatarsal L5 - S1- S2 Superficial fibular Eversion and plantarflexion of foot. Supports arches of foot

11 Fibularis Brevis Lower two-thirds of lateral surface of shaft of fibula Lateral tubercle base of 5th metatarsal L5 - S1- S2 Superficial fibular Eversion of foot Fibularis Tertius Distal part of medial surface of fibula Dorsomedial surface of base of 5 metatarsal L5-S1 Deep fibular Dorsiflexion and eversion of foot UPPER EXTREMITY Biceps Long head: supraglenoid tubercle of the scapula; Short head: apex of coracoid process Tuberosity of radius C5 - C6 Musculocutaneous Powerful flexor of the forearm at the elbow and supinator of the forearm; accessory flexor of the arm at the glenohumeral Brachialis Anterior aspect of humerus (medial and lateral surfaces) and adjacent intermuscular septae Tuberosity of ulna C5 - C6 Musculocutaneous (contribution of radial to lateral part of muscle) Powerful flexor of the forearm at the elbow. Triceps Long head - infraglenoid tubercle on scapula; Medial head - posterior surface of humerus Lateral head - posterior surface of humerus Olecranon process of ulna C6 - C7 - C8 Radial Extension of the forearm at the elbow; Long head - accessory adductor and extension of the arm at the glenohumeral Brachioradialis Proximal part of lateral supraepicondylar ridge of humerus and adjacent Lateral surface of distal end of radius C5 - C6 Radial Accessory flexor of elbow when forearm is mid-

12 intermuscular septum pronated Supinator Superficial part: lateral epicondyle of humerus, radial collateral and anular ligaments Lateral surface of radius superior to the anterior oblique line C6 - C7 Posterior interosseous Supination Deep Part: supinator crest of the ulna Pronator Teres Humeral head: medial epicondyle and adjacent supraepicondylar ridge Roughening on lateral surface mid shaft of radius C6 - C7 Median Pronation UInar Head: medial side of coronoid process Wrist Flexors Various attachments C6 - C7 - C8-T1 Wrist flexion Wrist Extensors Various attachments C6 - C7 - C8 Wrist extension