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SUMMARY OF SHOULDER (GLENOHUMERAL) JOINT MOVEMENTS AND MUSCLES PRODUCING THOSE MOVEMENTS
MOVEMENTS* MUSCLES ORIGIN INSERTION NERVE SUPPLY
Axillary nerve from posterior cord of brachial plexus Lateral pectoral nerve from lateral cord of brachial plexus Axillary nerve from posterior cord of brachial plexus Musculocutaneous nerve from lateral cord of brachial plexus Musculocutaneous nerve from lateral cord of brachial plexus Musculocutaneous nerve from lateral cord of brachial plexus Thoracodorsal nerve from posterior cord of brachial plexus

SEGMENTAL NERVE ROOTS**

C5, C6

Flexion

Deltoid (anterior fibers) Pectoralis major (clavicular head)

Lateral third of posterior clavicle Anterior surface of medial half of clavicle Lateral margin & superior surface of acromion Supraglenoid tubercle of scapula; Posterosuperior labrum Tip of coracoid process of scapula

Deltoid (middle fibers) Biceps brachii Long head

Biceps brachii Short head

Coracobrachialis

Tip of coracoid process of scapula

Deltoid tuberosity (middle of lateral humeral surface) Lateral lip of bicipital (intertubercular) groove of humerus Deltoid tuberosity (middle of lateral humeral surface) Tuberosity of radius and bicipital aponeurosis into deep fascia of forearm Tuberosity of radius and bicipital aponeurosis into deep fascia of forearm Middle third of medial surface of humerus Floor of bicipital (intertubercular) groove of humerus

C5, C6

C5, C6

C5, C6

C5, C6

C5, C6, C7

Extension

Latissimus dorsi

Teres major

Deltoid (posterior fibers) Pectoralis major (sternocostal head)

Posterior 1/3 of iliac crest, T7-T12 spinous processes, thoracolumbar fascia, lower 3-4 ribs, and inferior angle of scapula Lower one-third of lateral border of scapula (dorsal surface) near inferior angle Spine of scapula

C6, C7, C8

Medial lip of bicipital (intertubercular) groove of humerus Deltoid tuberosity (middle of lateral humeral surface) Lateral lip of bicipital (intertubercular) groove of humerus

Lower subscapular nerve from posterior cord of brachial plexus Axillary nerve from posterior cord of brachial plexus Medial and lateral pectoral nerves from medial and lateral cords of brachial plexus

C6, C7

C5, C6

Triceps Long head

Anterior surface of sternum, upper six costal cartilages, and aponeurosis of external oblique muscle Infraglenoid tubercle of scapula

C7, C8, and T1

Olecranon process of ulna

Radial nerve from posterior cord of brachial plexus

C6, C7, C8

Abduction

Deltoid (middle fibers)

Supraspinatus

Lateral margin and superior surface of acromion Supraspinous fossa of scapula

Deltoid tuberosity (middle of lateral humeral surface)

Deltoid (anterior and posterior fibers) Infraspinatus

Superior facet of greater tubercle of humerus; capsule of shoulder joint Lateral third of Deltoid tuberosity posterior clavicle; (middle of lateral Spine of scapula humeral surface) Middle facet of greater tubercle of humerus; capsule of shoulder joint Subscapular fossa Lesser tubercle of humerus Infraspinous fossa of scapula

Subscapularis

Adduction

Deltoid (posterior fibers)

Spine of scapula

Deltoid tuberosity (middle of lateral humeral surface) Lateral lip of bicipital (intertubercular) groove of humerus

Pectoralis major (sternocostal head)

Latissimus dorsi

Teres major

Anterior surface of sternum, upper six costal cartilages, and aponeurosis of external oblique muscle Posterior 1/3 of iliac crest, T7T12 spinous processes, thoracolumbar fascia, lower 3-4 ribs, and inferior angle of scapula Lower one-third of lateral border of scapula (dorsal surface) near inferior angle Infraglenoid tubercle of scapula Tip of coracoid process of scapula

Axillary nerve from posterior cord of brachial plexus Suprascapular nerve from upper trunk of brachial plexus Axillary nerve from posterior cord of brachial plexus Suprascapular nerve from upper trunk of brachial plexus Upper and lower subscapular nerves from posterior cord of brachial plexus Axillary nerve from posterior cord of brachial plexus Medial and lateral pectoral nerves from medial and lateral cords of brachial plexus

C5, C6

C5, C6

C5, C6

C5, C6

C5, C6

C5, C6

C7, C8, and T1

Floor of bicipital (intertubercular) groove of humerus

Thoracodorsal nerve from posterior cord of brachial plexus

C6, C7, C8

Medial lip of bicipital (intertubercular) groove of humerus

Lower subscapular nerve from posterior cord of brachial plexus

C6, C7

Triceps Long head Corachobrachialis

Olecranon process of ulna Middle third of medial surface of humerus

Radial nerve from posterior cord of brachial plexus Musculocutaneous nerve from lateral cord of brachial plexus

C6, C7, C8

C5, C6, C7

Transverse (Horizontal) Abduction (Extension)

Deltoid (posterior fibers)

Spine of scapula

Deltoid tuberosity (middle of lateral humeral surface)

Axillary nerve from posterior cord of brachial plexus Thoracodorsal nerve from posterior cord of brachial plexus

C5, C6

Latissimus dorsi

Teres major

Infraspinatus

Posterior 1/3 of iliac crest, T7T12 spinous processes, thoracolumbar fascia, lower 3-4 ribs, and inferior angle of scapula Lower one-third of lateral border of scapula (dorsal surface) near inferior angle Infraspinous fossa of scapula

Floor of bicipital (intertubercular) groove of humerus

C6, C7, C8

Medial lip of bicipital (intertubercular) groove of humerus Middle facet of greater tubercle of humerus; capsule of shoulder joint Inferior facet of greater tubercle of humerus; capsule of shoulder joint Lateral lip of bicipital (intertubercular) groove of humerus

Lower subscapular nerve from posterior cord of brachial plexus Suprascapular nerve from upper trunk of brachial plexus Axillary nerve from posterior cord of brachial plexus Medial and lateral pectoral nerves from medial and lateral cords of brachial plexus

C6, C7

C5, C6

Teres minor

Upper two-thirds of lateral border of scapula Anterior surface of sternum, upper six costal cartilages, and aponeurosis of external oblique muscle; Anterior surface of medial half of clavicle Lateral third of posterior clavicle

C5, C6

Transverse (Horizontal) Adduction (Flexion)

Pectoralis major (sternocostal and clavicular heads)

C5, C6, C7, C8, and T1

Deltoid (anterior fibers)

Deltoid tuberosity (middle of lateral humeral surface) Middle third of medial surface of humerus Tuberosity of radius and bicipital aponeurosis into deep fascia of forearm Tuberosity of radius and bicipital aponeurosis into deep fascia of forearm

Corachobrachialis

Tip of coracoid process of scapula Supraglenoid tubercle of scapula; Posterosuperior labrum Tip of coracoid process of scapula

Biceps brachii Long head

Axillary nerve from posterior cord of brachial plexus Musculocutaneous nerve from lateral cord of brachial plexus Musculocutaneous nerve from lateral cord of brachial plexus Musculocutaneous nerve from lateral cord of brachial plexus

C5, C6

C5, C6, C7

C5, C6

Biceps brachii Short head

C5, C6

Lateral Rotation

Infraspinatus

Infraspinous fossa of scapula

Teres minor

Upper two-thirds of lateral border of scapula Spine of scapula

Deltoid (posterior fibers)

Middle facet of greater tubercle of humerus; capsule of shoulder joint Inferior facet of greater tubercle of humerus; capsule of shoulder joint Deltoid tuberosity (middle of lateral humeral surface)

Supraspinatus

Supraspinous fossa of scapula

Medial rotation

Subscapularis

Superior facet of greater tubercle of humerus; capsule of shoulder joint Subscapular fossa Lesser tubercle of humerus

Latissimus dorsi

Teres major

Pectoralis major (sternocostal and clavicular heads)

Deltoid (anterior fibers)

Posterior 1/3 of iliac crest, T7T12 spinous processes, thoracolumbar fascia, lower 3-4 ribs, and inferior angle of scapula Lower one-third of lateral border of scapula (dorsal surface) near inferior angle Anterior surface of sternum, upper six costal cartilages, and aponeurosis of external oblique muscle; Anterior surface of medial half of clavicle Lateral third of posterior clavicle

Floor of bicipital (intertubercular) groove of humerus

Suprascapular nerve from upper trunk of brachial plexus Axillary nerve from posterior cord of brachial plexus Axillary nerve from posterior cord of brachial plexus Suprascapular nerve from upper trunk of brachial plexus Upper and lower subscapular nerves from posterior cord of brachial plexus Thoracodorsal nerve from posterior cord of brachial plexus

C5, C6

C5, C6

C5, C6

C5, C6

C5, C6

C6, C7, C8

Medial lip of bicipital (intertubercular) groove of humerus Lateral lip of bicipital (intertubercular) groove of humerus

Lower subscapular nerve from posterior cord of brachial plexus Medial and lateral pectoral nerves from medial and lateral cords of brachial plexus

C6, C7

C5, C6, C7, C8, and T1

Deltoid tuberosity (middle of lateral humeral surface)

Axillary nerve from posterior cord of brachial plexus

C5, C6

*Circumduction is a combination of all the movements described **The predominant segmental nerve supply is indicated by boldface type The primary muscles that produce each movement are shown in boldface type

SUMMARY OF STERNOCLAVICULAR AND ACROMIOCLAVICULAR JOINT MOVEMENTS AND MUSCLES PRODUCING THOSE MOVEMENTS
MOVEMENTS MUSCLES ORIGIN INSERTION NERVE SUPPLY SEGMENTAL NERVE ROOTS* XI cranial nerve (spinal part); C3, C4

Elevation

Trapezius (Upper Fibers)

Levator scapulae

External occipital protuberance and medial 1/3 of superior nuchal line, ligamentum nuchae, and spinous process of C7 Transverse processes of C1-C4 vertebrae

Lateral third of posterior clavicle

Spinal part of accessory nerve

Superior part of medial border of scapula near superior angle

C3 and C4; Dorsal C3, C4, C5 scapular nerve from C5 root

Rhomboid major

spines of T2-T5 Medial border vertebrae of scapula from level of spine of scapula to inferior angle Ligamentum nuchae and spines of C7-T1 vertebrae Third, fourth, and fifth ribs Medial border of scapula at level of spine of scapula Coracoid process of scapula

C4; Dorsal scapular nerve from C5 root

C4, C5

Rhomboid minor

C4; Dorsal scapular nerve from C5 root

C4, C5

Depression

Pectoralis minor

Trapezius (Lower Fibers) Subclavius

Spinous processes of T6-T12 Junction of first rib and its costal cartilage

Medial pectoral nerve from medial cord of brachial plexus Spine of scapula Spinal part of accessory nerve Inferior surface of middle third of clavicle Nerve to subclavius from upper trunk of brachial plexus

C8, T1

XI cranial nerve (spinal part); C3, C4 C5, C6

Protraction (Abduction)

Serratus anterior

External surfaces of lateral upper eight ribs Third, fourth, and fifth ribs

Pectoralis minor

Anterior surface of medial border and inferior angle of scapula Coracoid process of scapula

Long thoracic nerve from C5-C7 roots

C5, C6, C7

Medial pectoral nerve from medial cord of brachial plexus Spinal part of accessory nerve Dorsal scapular nerve from C5 root

C8, T1

Retraction (Adduction)

Trapezius (Middle Fibers) Rhomboid major

Spinous processes of T1-T5 spines of T2-T5 vertebrae

Acromion and spine of scapula Medial border of scapula from level of spine of scapula to inferior angle Medial border of scapula at level of spine of scapula Lateral third of posterior clavicle

XI cranial nerve (spinal part); C3, C4 C4, C5

Rhomboid minor

Ligamentum nuchae and spines of C7-T1 vertebrae External occipital protuberance and medial 1/3 of superior nuchal line, ligamentum nuchae, and spinous process of C7 Spinous processes of T6-T12 Transverse processes of C1-C4 vertebrae

C4; Dorsal scapular nerve from C5 root

C4, C5

Trapezius (Upper Fibers)

Spinal part of accessory nerve

XI cranial nerve (spinal part); C3, C4

Trapezius (Lower Fibers) Levator scapulae

Spine of scapula Spinal part of accessory nerve Superior part of medial border of scapula near superior angle

XI cranial nerve (spinal part); C3, C4 C3 and C4; Dorsal C3, C4, C5 scapular nerve from C5 root

Upward Rotation

Trapezius (Upper Fibers)

Trapezius (Lower Fibers) Serratus anterior

External occipital protuberance and medial 1/3 of superior nuchal line, ligamentum nuchae, and spinous process of C7 Spinous processes of T6-T12 External surfaces of lateral upper eight ribs Third, fourth, and fifth ribs

Lateral third of posterior clavicle

Spinal part of accessory nerve

XI cranial nerve (spinal part); C3, C4

Spine of scapula Spinal part of accessory nerve Anterior surface of medial border and inferior angle of scapula Coracoid process of scapula Long thoracic nerve from C5-C7 roots

XI cranial nerve (spinal part); C3, C4 C5, C6, C7

Downward Rotation

Pectoralis minor

Rhomboid major

Rhomboid minor

spines of T2-T5 Medial border vertebrae of scapula from level of spine of scapula to inferior angle Ligamentum Medial border nuchae and of scapula at spines of C7-T1 level of spine of vertebrae scapula Transverse processes of C1-C4 vertebrae
Posterior 1/3 of iliac crest, T7T12 spinous processes, thoracolumbar fascia, lower 3-4 ribs, and inferior angle of scapula

Medial pectoral nerve from medial cord of brachial plexus C4; Dorsal scapular nerve from C5 root

C8, T1

C4, C5

C4; Dorsal scapular nerve from C5 root

C4, C5

Levator scapulae

Superior part of medial border of scapula near superior angle

Floor of bicipital (intertubercular) groove of humerus

C3 and C4; Dorsal C3, C4, C5 scapular nerve from C5 root

Thoracodorsal nerve from posterior cord of brachial plexus C6, C7, C8

Latissimus dorsi

*The predominant segmental nerve supply is indicated by boldface type The primary muscles that produce each movement are shown in boldface type

SUMMARY OF ELBOW (HUMEROULNAR AND HUMERORADIAL) JOINT MOVEMENTS AND MUSCLES PRODUCING THOSE MOVEMENTS
MOVEMENTS MUSCLES ORIGIN INSERTION NERVE SUPPLY SEGMENTAL NERVE ROOTS* C5, C6

Flexion

Biceps brachii

Long Head: Supraglenoid tubercle of scapula and posterosuperior labrum; Short Head: Tip of coracoid process of scapula

Tuberosity of radius and bicipital aponeurosis into deep fascia of forearm

Musculocutaneous nerve from lateral cord of brachial plexus

Brachialis

Distal half of anterior surface of humerus

Proximal twothirds of lateral supracondylar ridge of humerus Humeral Head: Medial epicondyle of humerus; Ulnar Head: Coronoid process of ulna Long Head: infraglenoid tubercle of scapula; Lateral Head: Upper half of posterior surface of humerus (superior to radial groove); Medial Head: lower half of posterior surface of shaft of humerus (inferior to radial groove) Lateral epicondyle of humerus

Coronoid process and ulnar tuberosity Base of styloid process of radius Lateral surface of middle third of radius

Brachioradialis

Musculocutaneous nerve from lateral cord of brachial plexus Radial nerve from posterior cord of brachial plexus Median nerve from medial and lateral cords of brachial plexus

C5, C6

C5, C6, C7

Pronator teres

C6, C7

Extension

Triceps

Olecranon process of ulna

Radial nerve from posterior cord of brachial plexus

C6, C7, C8

Radial nerve from Lateral surface of olecronon and posterior cord of brachial plexus superior part of posterior surface of ulna *The predominant segmental nerve supply is indicated by boldface type The primary muscles that produce each movement are shown in boldface type Anconeus

C7, C8, T1

SUMMARY OF RADIOULNAR JOINT MOVEMENTS AND MUSCLES PRODUCING THOSE MOVEMENTS

MOVEMENTS MUSCLES ORIGIN INSERTION NERVE SUPPLY SEGMENTAL NERVE ROOTS*
C5, C6

Supination

Biceps brachii

Supinator

Brachioradialis

Extensor carpi radialis longus

Pronation

Pronator teres

Pronator quadratus Brachioradialis

Long Head: Supraglenoid tubercle of scapula and posterosuperior labrum; Short Head: Tip of coracoid process of scapula Lateral epicondyle of humerus, radial collateral and anular ligament, supinator fossa, and crest of ulna Proximal twothirds of lateral supracondylar ridge of humerus Lateral supracondylar ridge of humerus Humeral Head: Medial epicondyle of humerus; Ulnar Head: Coronoid process of ulna Anterior surface of shaft of ulna Proximal twothirds of lateral supracondylar ridge of humerus Medial epicondyle of humerus

Tuberosity of radius and bicipital aponeurosis into deep fascia of forearm

Musculocutaneous nerve from lateral cord of brachial plexus

Lateral, posterior, and anterior surfaces of proximal third of radius

Deep branch of radial nerve

C6, C7

Base of styloid process of radius

Radial nerve from posterior cord of brachial plexus Radial nerve from posterior cord of brachial plexus Median nerve from medial and lateral cords of brachial plexus

C5, C6, C7

Posterior surface of base of second metacarpal bone Lateral surface of middle third of radius

C6, C7

C6, C7

Anterior surface of shaft of radius Base of styloid process of radius

Anterior interosseous branch of median nerve Radial nerve from posterior cord of brachial plexus Median nerve from medial and lateral cords of brachial plexus

C8, T1

C5, C6, C7

Flexor carpi radialis

Bases of second and third metacarpal bones

C6, C7

*The predominant segmental nerve supply is indicated by boldface type The primary muscles that produce each movement are shown in boldface type

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SUMMARY OF RADIOCARPAL (WRIST) AND MIDCARPAL JOINT MOVEMENTS AND MUSCLES PRODUCING THOSE MOVEMENTS
MOVEMENTS MUSCLES ORIGIN INSERTION NERVE SUPPLY
Median nerve from medial and lateral cords of brachial plexus Ulnar nerve from medial cord of brachial plexus

Flexion

Flexor carpi radials

Medial epicondyle of humerus Humeral Head: medial epicondyle of humerus; Ulnar Head: olecranon process, posterior border of ulna Humeroulnar Head: Medial epicondyle of humerus, coroniod process of ulna; Radial Head: oblique line anterior surface shaft of radius Anteromedial surface of shaft of ulna; interosseous membrane

Bases of second and third metacarpal bones Pisiform bone, hook of the hamate, base at fifth metacarpal bone

SEGMENTAL NERVE ROOTS* C6, C7

Flexor carpi ulnaris

C7, C8, T1

Flexor digitorum superficialis

Base of middle phalanx of medial four fingers

Median nerve from medial and lateral cords of brachial plexus

C7, C8, T1

Flexor digitorum profundus

Base of distal phalanges of medial four fingers

Palmaris longus

Medial epicondyle of humerus

Distal half of flexor retinaculum and palmar aponeurosis Base of distal phalanx of thumb

C8, T1 Ulnar nerve (medial half) and anterior interosseus branch of median nerve (lateral half) C7, C8 Median nerve from medial and lateral cords of brachial plexus

Flexor pollicis longus

Anterior surface of radius and adjacent interosseous membrane

C8, T1 Anterior interosseous branch of median nerve

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Extension

Extensor carpi radialis longus Extensor carpi radialis brevis Extensor carpi ulnaris

Lateral supracondylar ridge of humerus Lateral epicondyle of humerus Lateral epicondyle of humerus

Base of second metacarpal bone Base of third metacarpal bone Base of fifth metacarpal bone

Radial nerve from posterior cord of brachial plexus Deep branch of radial nerve Posterior interosseous nerve the continuation of the deep branch of radial nerve Posterior interosseous nerve the continuation of the deep branch of radial nerve

C6, C7 C7, C8 C7, C8

Extensor digitorum

Lateral epicondyle of humerus

Extensor indicis

Posterior surface of ulna and interosseous membrane

Extensor digiti minimi

Lateral epicondyle of humerus

Extensor pollicis longus

Posterior surface of middle third of ulna and interosseous membrane

Extensor expansion (transverse fibers of dorsal hood, central and lateral bands, oblique retinacular ligaments) of middle and distal phalanges of medial four digits Extensor expansion (transverse fibers of dorsal hood, central and lateral bands, oblique retinacular ligaments) of index finger Extensor expansion (transverse fibers of dorsal hood, central and lateral bands, oblique retinacular ligaments) of little finger Base of distal phalanx of thumb

C7, C8

Posterior interosseous nerve the continuation of the deep branch of radial nerve

C7, C8

Posterior interosseous nerve the continuation of the deep branch of radial nerve

C7, C8

Posterior interosseous nerve the continuation of the deep branch of radial nerve

C7, C8

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Abduction (radial deviation)

Flexor carpi radials

Medial epicondyle of humerus

Lateral supracondylar ridge of humerus Extensor carpi Lateral epicondyle of radialis brevis humerus Abductor Posterior surface pollicis longus of radius (middle third) and ulna; interosseous membrane Extensor pollicis Posterior surface longus of middle third of ulna and interosseous membrane Extensor carpi radialis longus Extensor pollicis Posterior surface brevis of radius and interosseous membrane

Bases of second and third metacarpal bones Base of second metacarpal bone

Base of third metacarpal bone Base of first metacarpal

Median nerve from medial and lateral cords of brachial plexus Radial nerve from posterior cord of brachial plexus Deep branch of radial nerve Posterior interosseous nerve the continuation of the deep branch of radial nerve Posterior interosseous nerve the continuation of the deep branch of radial nerve Posterior interosseous nerve the continuation of the deep branch of radial nerve Ulnar nerve from medial cord of brachial plexus

C6, C7

C6, C7

C7, C8

C7, C8

Base of distal phalanx of thumb

C7, C8

Base of proximal phalanx of thumb

C7, C8

Adduction (ulnar deviation)

Flexor carpi ulnaris

Extensor carpi ulnaris

Humeral Head: medial epicondyle of humerus; Ulnar Head: olecranon process, posterior border of ulna Lateral epicondyle of humerus

Pisiform bone, hook of the hamate, base at fifth metacarpal bone

C7, C8, T1

Base of fifth metacarpal bone

Posterior interosseous nerve the continuation of the deep branch of radial nerve

C7, C8

*The predominant segmental nerve supply is indicated by boldface type The primary muscles that produce each movement are shown in boldface type

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SUMMARY OF CARPOMETACARPAL JOINT MOVEMENTS OF THE THUMB AND MUSCLES PRODUCING THOSE MOVEMENTS
MOVEMENTS MUSCLES ORIGIN INSERTION NERVE SUPPLY Superficial Head: Recurrent branch of median nerve; Deep Head: Deep branch of ulnar nerve Deep branch of ulnar nerve SEGMENTAL NERVE ROOTS* C8, T1

Flexion

Flexor pollicis brevis**

Adductor pollicis

Opponens pollicis

Superficial Head: Trapezium and flexor retinaculum; Deep Head: Trapezoid and capitate Oblique Head: capitate and bases of 2nd and 3rd metacarpals; Transverse Head: 3rd metacarpal bone (distal 2/3 of palmar surface) Flexor retinaculum and trapezium

Lateral (radial) side of base of proximal phalanx of thumb

Medial side of base of proximal phalanx of thumb

C8, T1

Flexor pollicis longus

Extension

Extensor pollicis longus

Extensor pollicis brevis

Lateral side of shaft of metacarpal bone of thumb Anterior surface Base of distal of radius and phalanx of adjacent thumb (palmar interosseous surface) membrane Posterior Base of distal surface of phalanx of middle third of thumb (dorsal ulna and surface) interosseous membrane Posterior Base of surface of proximal radius and phalanx of interosseous thumb (dorsal membrane surface) Posterior surface of radius (middle third) and ulna; interosseous membrane Base of first metacarpal

Recurrent branch of median nerve Anterior interosseous branch of median nerve Posterior interosseous nerve the continuation of the deep branch of radial nerve Posterior interosseous nerve the continuation of the deep branch of Radial nerve Posterior interosseous nerve the continuation of the deep branch of radial nerve

C8, T1

C8, T1

C7, C8

C7, C8

Abductor pollicis longus

C7, C8

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Abduction

Abductor pollicis longus

Abductor pollicis brevis Opponens pollicis

Adduction

Adductor pollicis

1st Dorsal Interosseus

Posterior surface of radius (middle third) and ulna; interosseous membrane Scaphoid, trapezium, and flexor retinaculum Flexor retinaculum and trapezium Oblique head: capitate and bases of 2nd and 3rd metacarpals; Transverse head: 3rd metacarpal (distal 2/3 of palmar surface) Originates from opposing sides of adjacent metacarpal bones I & II (bipennate muscles)

Base of first metacarpal

Lateral side of base of proximal phalanx of thumb Lateral side of shaft of 1st metacarpal Medial side of base of proximal phalanx of thumb

Posterior interosseous nerve the continuation of the deep branch of radial nerve Recurrent branch of median nerve Recurrent branch of median nerve Deep branch of ulnar nerve

C7, C8

C8, T1

C8, T1

C8, T1

Extensor pollicis longus

Opposition***

Opponens pollicis

Posterior surface of middle third of ulna and interosseous membrane Flexor retinaculum and trapezium Superficial Head: Trapezium and flexor retinaculum; Deep Head: Trapezoid and capitate Scaphoid, trapezium, and flexor retinaculum

Base of proximal phalanx of 2nd digit (radial side) and extensor expansion (oblique fibers of dorsal hood, central and lateral bands, oblique retinacular ligaments) Base of distal phalanx of thumb (dorsal surface)

Deep branch of ulnar nerve

C8, T1

Flexor pollicis brevis**

Lateral side of shaft of metacarpal bone of thumb Lateral (radial) side of base of proximal phalanx of thumb

Posterior interosseous nerve the continuation of the deep branch of radial nerve Recurrent branch of median nerve

C7, C8

C8, T1

Superficial Head: Recurrent branch of median nerve; Deep Head: Deep branch of ulnar nerve Recurrent branch of median nerve

C8, T1

Abductor pollicis brevis

Lateral side of base of proximal phalanx of thumb

C8, T1

*The predominant segmental nerve supply is indicated by boldface type ** The deep portion of the flexor pollicis brevis is sometimes called the first palmar interosseous muscle due to its similar innervation and position on the thumb ***The opponens digiti minimi, which originates on the flexor retinaculum and hamate, inserts into the medial border of the 5th metacarpal, and is innervated by the deep branch of the ulnar nerve (C8, T1), works synergistically with the opponens pollicis to complete opposition. The primary muscles that produce each movement are shown in boldface type

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SUMMARY OF METACAROPHALANGEAL JOINT MOVEMENTS AND MUSCLES PRODUCING THOSE MOVEMENTS

MOVEMENTS MUSCLES ORIGIN INSERTION NERVE SUPPLY Median nerve from medial and lateral cords of brachial plexus SEGMENTAL NERVE ROOTS* C7, C8, T1

Flexion

Flexor digitorum superficialis

(2nd, 3rd, 4th, & 5th fingers)

Flexor digitorum profundus

(2nd, 3rd, 4th, & 5th fingers)

Humeroulnar Head: Medial epicondyle of humerus, coroniod process of ulna; Radial Head: oblique line anterior surface shaft of radius Anteromedial surface of shaft of ulna; interosseous membrane

Base of middle phalanx of medial four fingers

Base of distal Ulnar nerve phalanges of medial (medial four fingers half) and anterior interosseus branch of median nerve (lateral half) Medial side of base of proximal phalanx of little finger Lateral (radial) sides of extensor expansion (oblique fibers of dorsal hood, central and lateral bands, oblique retinacular ligaments) of medial four fingers (digits 2-5): 1st lumbrical to digit 2; 2nd lumbrical to digit 3; 3rd lumbrical to digit 4; 4th lumbrical to digit 5

C8, T1

Flexor digiti minimi (little finger) Lumbricals (1-4)

(2nd, 3rd, 4th, & 5th fingers)

Hook of Hamate and Flexor retinaculum

Deep branch C8, T1 of ulnar nerve Lumbricals 1-2 (median nerve) Lumbricals 3-4 (deep branch of ulnar nerve) C8, T1

Lumbricals 1-2: Arises from a single head (unipennate) on the radial side of the lateral two tendons (1st and 2nd) of the flexor digitorum profundus (along index and ring fingers); Lumbricals 3-4: Arises from double heads (bipennate) of the medial three tendons (2nd, 3rd, and 4th) of the flexor digitorum profundus (3rd lumbrical between long and ring fingers; 4th lumbrical between ring and little fingers)

16 Palmar Interossei (1-3)** (2nd, 4th, & 5th fingers) Sides of palmar surface of 2nd, 4th, and 5th metacarpals: 1st (ulnar side of 2nd digit); 2nd (radial side of 4th digit); 3rd (radial side of 5th digit) Extensor expansion (oblique fibers of dorsal hood, central and lateral bands, oblique retinacular ligaments) and bases of proximal phalanges of digits 2, 4, and 5: 1st (ulnar side of digit 2); 2nd (radial side of digit 4); 3rd (radial side of digit 5) Extensor expansion (oblique fibers of dorsal hood, central and lateral bands, oblique retinacular ligaments) and bases of proximal phalanges of digits 2-4: 1st (radial side of digit 2); 2nd (radial side of digit 3); 3rd (ulnar side of digit 3); 4th (ulnar side of digit 4) Base of distal phalanx of thumb (palmar surface) Deep branch C8, T1 of ulnar nerve

Dorsi Interossei (1-4) (2nd, 3rd, & 4th fingers)

Each originates from opposing sides of two adjacent metacarpal bones I & II (1st), II & III (2nd), III & IV (3rd), IV & V (4th) bipennate muscles

Deep branch C8, T1 of ulnar nerve

Flexor pollicis longus (thumb) Flexor pollicis brevis** (thumb)

Anterior surface of radius and adjacent interosseous membrane Superficial Head: Trapezium and flexor retinaculum; Deep Head: Trapezoid and capitate

Lateral (radial) side of base of proximal phalanx of thumb

Adductor pollicis (thumb)

Oblique Head: capitate and bases of 2nd and 3rd metacarpals; Transverse Head: 3rd metacarpal bone (distal 2/3 of palmar surface)

Medial side of base of proximal phalanx of thumb

Anterior C8, T1 interosseous branch of median nerve Superficial C8, T1 Head: Recurrent branch of median nerve; Deep Head: Deep branch of ulnar nerve Deep branch C8, T1 of ulnar nerve

17

Extension

Extensor digitorum (2nd, 3rd, 4th, & 5th fingers) Extensor digiti minimi (little finger) Extensor indicis (2nd finger)

Lateral epicondyle of humerus

Extensor expansion (transverse fibers of dorsal hood, central and lateral bands, oblique retinacular ligaments) of middle and distal phalanges of medial four digits

Posterior interosseous nerve the continuation of the deep branch of radial nerve Posterior interosseous nerve the continuation of the deep branch of radial nerve Posterior interosseous nerve the continuation of the deep branch of radial nerve Posterior interosseous nerve the continuation of the deep branch of radial nerve Posterior interosseous nerve the continuation of the deep branch of radial nerve Deep branch of ulnar nerve

C7, C8

Lateral epicondyle of humerus

Posterior surface of ulna and interosseous membrane

Extensor pollicis longus (thumb) Extensor pollicis brevis (thumb)

Posterior surface of middle third of ulna and interosseous membrane

Extensor expansion (transverse fibers of dorsal hood, central and lateral bands, oblique retinacular ligaments) of little finger Extensor expansion (transverse fibers of dorsal hood, central and lateral bands, oblique retinacular ligaments) of index finger Base of distal phalanx of thumb (dorsal surface)

C7, C8

C7, C8

C7, C8

Posterior surface of radius and interosseous membrane

Base of proximal phalanx of thumb (dorsal surface)

C7, C8

Abduction

Abductor digiti minimi (little finger) Dorsi Interossei (1-4) (2nd, 3rd, & 4th fingers)

Pisiform bone

Medial side of base of proximal phalanx of little finger

Extensor expansion (oblique fibers of dorsal hood, central and lateral bands, oblique retinacular ligaments) and bases of proximal phalanges of digits 2-4: 1st (radial side of digit 2); 2nd (radial side of digit 3); 3rd (ulnar side of digit 3); 4th (ulnar side of digit 4) Extensor expansion (oblique fibers of dorsal hood, central and lateral bands, oblique retinacular ligaments) and bases of proximal phalanges of digits 2, 4, and 5: 1st (ulnar side of digit 2); 2nd (radial side of digit 4); 3rd (radial side of digit 5)

C8, T1

Each originates from opposing sides of two adjacent metacarpal bones I & II (1st), II & III (2nd), III & IV (3rd), IV & V (4th) - bipennate muscles

Deep branch of ulnar nerve

C8, T1

Adduction

Palmar Interossei (1-3)** (2nd, 4th, & 5th fingers)

Sides of palmar surface of 2nd, 4th, and 5th metacarpals: 1st (ulnar side of 2nd digit); 2nd (radial side of 4th digit); 3rd (radial side of 5th digit)

Deep branch of ulnar nerve

C8, T1

*The predominant segmental nerve supply is indicated by boldface type ** The deep portion of the flexor pollicis brevis is sometimes called the first palmar interosseous muscle due to its similar innervation and position on the thumb The primary muscles that produce each movement are shown in boldface type

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SUMMARY OF PROXIMAL (PIP) AND DISTAL (DIP) INTERPHALANGEAL JOINT MOVEMENTS OF THE FINGERS, INTERPHALANGEAL (IP) JOINT MOVEMENTS OF THE THUMB, AND THE MUSCLES PRODUCING THOSE MOVEMENTS
MOVEMENTS MUSCLES
Flexor digitorum superficialis (PIP) (2nd, 3rd, 4th, & 5th fingers) Flexor digitorum profundus (PIP & DIP) (2nd, 3rd, 4th, & 5th fingers) Flexor pollicis longus (IP)

ORIGIN
Humeroulnar Head: Medial epicondyle of humerus, coroniod process of ulna; Radial Head: oblique line anterior surface shaft of radius Anteromedial surface of shaft of ulna; interosseous membrane

INSERTION
Base of middle phalanx of medial four fingers

NERVE SUPPLY
Median nerve from medial and lateral cords of brachial plexus Ulnar nerve (medial half) and anterior interosseus branch of median nerve (lateral half) Anterior interosseous branch of median nerve Posterior interosseous nerve continuation of deep branch of radial nerve Posterior interosseous nerve continuation of deep branch of radial nerve Posterior interosseous nerve continuation of deep branch of radial nerve Posterior interosseous nerve continuation of deep branch of radial nerve

SEGMENTAL NERVE ROOTS*

Flexion

C7, C8, T1

Base of distal phalanges of medial four fingers

C8, T1

Anterior surface of radius and adjacent interosseous membrane Lateral epicondyle of humerus

Base of distal phalanx of thumb (palmar surface)

C8, T1

Extension

(thumb) Extensor digitorum (PIP & DIP) (2nd, 3rd, 4th, & 5th fingers) Extensor indicis (PIP & DIP) (2nd finger)

Posterior surface of ulna and interosseous membrane

Extensor digiti minimi (PIP & DIP) (little finger)

Lateral epicondyle of humerus

Extensor pollicis longus (IP) (thumb)

Posterior surface of middle third of ulna and interosseous membrane

Extensor expansion (transverse fibers of dorsal hood, central and lateral bands, oblique retinacular ligaments) of middle and distal phalanges of medial four digits Extensor expansion (transverse fibers of dorsal hood, central and lateral bands, oblique retinacular ligaments) of index finger Extensor expansion (transverse fibers of dorsal hood, central and lateral bands, oblique retinacular ligaments) of little finger Base of distal phalanx of thumb (dorsal surface)

C7, C8

C7, C8

C7, C8

C7, C8

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Lumbricals (1-4) (PIP & DIP) (2nd, 3rd, 4th, & 5th fingers) Lumbricals 1-2: Arises from a single head (unipennate) on the radial side of the lateral two tendons (1st and 2nd) of the flexor digitorum profundus (along index and ring fingers); Lumbricals 3-4: Arises from double heads (bipennate) of the medial three tendons (2nd, 3rd, and 4th) of the flexor digitorum profundus (3rd lumbrical between long and ring fingers; 4th lumbrical between ring and little fingers) Sides of palmar surface of 2nd, 4th, and 5th metacarpals: 1st (ulnar side of 2nd digit); 2nd (radial side of 4th digit); 3rd (radial side of 5th digit) Lateral (radial) sides of extensor expansion (oblique fibers of dorsal hood, central and lateral bands, oblique retinacular ligaments) of medial four fingers (digits 2-5): 1st lumbrical to digit 2; 2nd lumbrical to digit 3; 3rd lumbrical to digit 4; 4th lumbrical to digit 5 Lumbricals 1-2 (median nerve) Lumbricals 3-4 (deep branch of ulnar nerve C8, T1

Palmar Interossei (1-3)** (PIP & DIP) (2nd, 4th, & 5th fingers)

Dorsi Interossei (1-4) (PIP & DIP) (2nd, 3rd, and 4th fingers)

Each originates from opposing sides of two adjacent metacarpal bones I & II (1st), II & III (2nd), III & IV (3rd), IV & V (4th) bipennate muscles

Extensor expansion (oblique fibers of dorsal hood, central and lateral bands, oblique retinacular ligaments) and bases of proximal phalanges of digits 2, 4, and 5: 1st (ulnar side of digit 2); 2nd (radial side of digit 4); 3rd (radial side of digit 5) Extensor expansion (oblique fibers of dorsal hood, central and lateral bands, oblique retinacular ligaments) and bases of proximal phalanges of digits 2-4: 1st (radial side of digit 2); 2nd (radial side of digit 3); 3rd (ulnar side of digit 3); 4th (ulnar side of digit 4)

Deep branch C8, T1 of ulnar nerve

Deep branch C8, T1 of ulnar nerve

*The predominant segmental nerve supply is indicated by boldface type ** The deep portion of the flexor pollicis brevis is sometimes called the first palmar interosseous muscle due to its similar innervation and position on the thumb The primary muscles that produce each movement are shown in boldface type

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SUMMARY OF HIP JOINT MOVEMENTS AND MUSCLES PRODUCING THOSE MOVEMENTS

MOVEMENTS* MUSCLES
Iliacus***

ORIGIN

INSERTION

NERVE SUPPLY
Femoral nerve Lumbar plexus

SEGMENTAL NERVE ROOTS**

L2, L3

Flexion

Psoas major and minor***

Rectus femoris

Iliac crest, iliac fossa, ala of sacrum, and anterior sacroiliac ligaments Transverse processes, bodies, and intervertebral discs of 12th thoracic and 1st lumbar (psoas minor) and 2nd through 5th lumbar vertebrae (psoas major) Straight head: anterior inferior iliac spine Reflected head: ilium above acetabulum

With psoas into lesser trochanter of femur With iliacus into lesser trochanter of femur

Psoas major: (L1, L2, L3) Psoas minor: (L1, L2)

Sartorius

Anterior superior iliac spine and superior part of notch inferior to it Body of pubis, medial to pubic tubercle and inferior to pubic crest Superior ramus of pubis

Adductor longus

Pectineus

Quadriceps tendon into patella, then via ligamentum patellae into tubercle of tibia Upper medial surface of shaft of tibia (pes anserinus) Middle third of linea aspera on posterior surface of femur Upper end of linea aspera of shaft of femur, just inferior to lesser trochanter Iliotibial tract that attaches to lateral condyle of tibia (Gerdy tubercle) Pectineal line and proximal portion of linea aspera on posterior femur Gluteal tuberosity, entire length of linea aspera, & medial supracondylar line Lateral surface of greater trochanter of femur

Femoral nerve

L2, L3, L4

Femoral nerve

L2, L3

Tensor fasciae latae

Anterior superior iliac spine and anterior part of iliac crest

Obturator nerve, anterior division Femoral nerve (may receive branch from obturator nerve) Superior gluteal nerve

L2, L3, L4

L2, L3

L5, S1

Adductor brevis

Body and inferior ramus of pubis

Adductor magnus (Adductor Portion)

Inferior ramus of pubis, ramus of ischium

Obturator nerve, anterior division Obturator nerve, posterior division

L2, L3, L4

L2, L3, L4

Gluteus medius (anterior fibers)

Outer surface of ilium between anterior and posterior gluteal lines

Superior gluteal nerve

L5, S1

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Extension

Gluteus maximus

Biceps femoris (long head)

Outer posterior surface of ilium (posterior to gluteal line), dorsal sacrum and coccyx, sacrotuberous ligament Ischial tuberosity

Iliotibial tract and gluteal tuberosity of femur

Inferior gluteal nerve

L5, S1, S2

Semitendinosus

Ischial tuberosity

Semimembranosus Ischial tuberosity

Adductor magnus- Ischial tuberosity hamstring (ischial) portion Gluteus medius (posterior fibers) Outer surface of ilium between anterior and posterior gluteal lines

Lateral side of head of fibula; Tendon is split at this site by fibular collateral ligament of knee Upper part of medial surface of shaft of tibia (pes anserinus) Posterior part of medial condyle of tibia; Reflected attachment forms oblique popliteal ligament (to lateral femoral condyle) Adductor tubercle of femur Lateral surface of greater trochanter of femur

Tibial portion of sciatic nerve

L5, S1, S2

Tibial portion of sciatic nerve Tibial portion of sciatic nerve

L5, S1, S2

L5, S1, S2

Tibial portion of sciatic nerve Superior gluteal nerve

L4

L5, S1

22

Abduction

Gluteus medius

Gluteus minimus

Tensor fasciae latae

Sartorius

Piriformis

Outer surface of ilium between anterior and posterior gluteal lines Outer surface of ilium between anterior and inferior gluteal lines Anterior superior iliac spine and anterior part of iliac crest Anterior superior iliac spine and superior part of notch inferior to it Anterior surface of sacrum (S2-S4 segments) and sacrotuberous ligament Outer posterior surface of ilium (posterior to gluteal line), dorsal sacrum and coccyx, sacrotuberous ligament

Lateral surface of greater trochanter of femur

Superior gluteal nerve

L5, S1

Anterior surface Superior of greater gluteal nerve trochanter of femur

L5, S1

Iliotibial tract that attaches to lateral condyle of tibia (Gerdy tubercle) Upper medial surface of shaft of tibia (pes anserinus)

Superior gluteal nerve

L5, S1

Femoral nerve

L2, L3

Upper border of greater trochanter of femur

Nerve to piriformis

S1, S2

Gluteus maximus (upper fibers)

Iliotibial tract and gluteal tuberosity of femur

Inferior gluteal L5, S1, S2 nerve

23

Adduction

Adductor longus

Adductor brevis

Body of pubis, medial to pubic tubercle and inferior to pubic crest Body and inferior ramus of pubis

Middle third of Obturator linea aspera on nerve, anterior division posterior surface of femur Pectineal line and proximal portion of linea aspera on surface of posterior femur Upper part of shaft of tibia on medial surface (pes anserinus) Gluteal tuberosity, entire length of linea aspera, and medial supracondylar line Adductor tubercle of femur Upper end of linea aspera of shaft of femur, just inferior to lesser trochanter Medial surface of greater trochanter and trochanteric fossa of femur Iliotibial tract and gluteal tuberosity of femur Obturator nerve, anterior
division

L2, L3, L4

L2, L3, L4

Gracilis

Body and inferior ramus of pubis Inferior ramus of pubis, ramus of ischium

Obturator nerve

L2, L3

Adductor magnus (Adductor Portion)

Obturator nerve, posterior

division

L2, L3, L4

Adductor magnushamstring (ischial) portion Pectineus

Ischial tuberosity Superior ramus of pubis

Obturator externus

Outer surface of obturator membrane and pubic and ischial rami Outer posterior surface of ilium (posterior to gluteal line), dorsal sacrum and coccyx, sacrotuberous ligament

Tibial portion of sciatic nerve Femoral nerve (may receive branch from obturator nerve) Obturator nerve

L4

L2, L3

L3, L4

Gluteus maximus (lower fibers)

Inferior gluteal L5, S1, S2 nerve

24

Lateral rotation

Gluteus maximus

Iliacus***

Psoas major and minor***

Sartorius

Piriformis

Obturator externus

Outer posterior surface of ilium (posterior to gluteal line), dorsal sacrum and coccyx, sacrotuberous ligament Iliac crest, iliac fossa, ala of sacrum, and anterior sacroiliac ligaments Transverse processes, bodies, and intervertebral discs of 12th thoracic and 1st lumbar (psoas minor) and 2nd through 5th lumbar vertebrae (psoas major) Anterior superior iliac spine and superior part of notch inferior to it Anterior surface of sacrum (S2S4) and sacrotuberous ligament Outer surface of obturator membrane; pubic and ischial rami

Iliotibial tract and gluteal tuberosity of femur

Inferior gluteal nerve

L5, S1, S2

With psoas into lesser trochanter of femur

Femoral nerve

L2, L3

With iliacus into lesser trochanter of femur

Lumbar plexus

Psoas major: (L1, L2, L3) Psoas minor: (L1, L2)

Upper medial surface of shaft of tibia (pes anserinus)

Femoral nerve

L2, L3

Upper border of greater trochanter of femur Medial surface of greater trochanter and trochanteric fossa of femur

Nerve to piriformis

S1, S2

Obturator nerve

L3, L4

Obturator internus

Inner surface of obturator membrane

Superomedial surface of greater trochanter and trochanteric fossa of femur

Nerve to obturator internus

L5, S1

25
Gemellus superior Spine of ischium Superomedial surface of greater trochanter (trochanteric fossa); Blends with tendon of obturator internus Superomedial surface of greater trochanter (trochanteric fossa); Blends with tendon of obturator internus Quadrate tubercle on intertrochanteric crest of femur and area inferior to it Lateral surface of greater trochanter of femur Lateral side of head of fibula; Tendon is split at this site by fibular collateral ligament of knee Nerve to obturator internus L5, S1

Gemellus inferior

Ischial tuberosity

Nerve to quadratus femoris

L5, S1

Quadratus femoris

Lateral border of ischial tuberosity

Nerve to quadratus femoris

L5, S1

Gluteus medius (posterior fibers)

Biceps femoris (long head)

Outer surface of ilium between anterior and posterior gluteal lines Ischial tuberosity

Superior gluteal nerve

L5, S1

Tibial portion of sciatic nerve

L5, S1, S2

26

Medial rotation

Outer surface of ilium between anterior and posterior gluteal lines Outer surface of Gluteus minimus ilium between anterior and inferior gluteal lines Tensor fasciae latae Anterior superior iliac spine and anterior part of iliac crest Semitendinosus Ischial tuberosity Gluteus medius (anterior fibers)

Lateral surface of greater trochanter of femur Anterior surface of greater trochanter of femur Iliotibial tract that attaches to lateral condyle of tibia (Gerdy tubercle) Upper part of medial surface of shaft of tibia (pes anserinus) Posterior part of medial condyle of tibia; Reflected attachment forms oblique popliteal ligament (to lateral femoral condyle) Gluteal tuberosity, entire length of linea aspera, and medial supracondylar line Middle third of linea aspera on posterior surface of femur

Superior gluteal nerve

L5, S1

Superior gluteal nerve

L5, S1

Superior gluteal nerve

L5, S1

Tibial portion of sciatic nerve

L5, S1, S2

Semimembranosus

Ischial tuberosity

Tibial portion of sciatic nerve

L5, S1, S2

Adductor magnus (Adductor Portion)****

Inferior ramus of pubis, ramus of ischium

Obturator nerve, posterior division

L2, L3, L4

Adductor longus**** Body of pubis, medial to pubic tubercle and inferior to pubic crest

Obturator nerve, anterior

division

L2, L3, L4

*Circumduction is a combination of all the movements described **The predominant segmental nerve supply is indicated by boldface type ***Often the iliacus and Psoas major and minor are collectively referred to as the iliopsoas muscle ****The role of the adductor muscles as medial rotators vary according to hip position in select positions the adductors may either medially or laterally rotate the hip The primary muscles that produce each movement are shown in boldface type

27

SUMMARY OF KNEE (TIBIOFEMORAL) JOINT MOVEMENTS AND MUSCLES PRODUCING THOSE MOVEMENTS
MOVEMENTS MUSCLES ORIGIN INSERTION NERVE SUPPLY Long Head: Tibial portion of sciatic nerve Short Head: Common peroneal (fibular) portion of sciatic nerve SEGMENTAL NERVE ROOTS* L5, S1, S2

Flexion

Biceps femoris (Two heads)

Semimembranosus

Long Head: Ischial tuberosity Short Head: Linea aspera of femur, entire length of lateral lip, and lateral supracondylar line) Ischial tuberosity

Lateral side of head of fibula; Tendon is split at this site by fibular collateral ligament of knee

Semitendinosus

Ischial tuberosity

Sartorius

Gracilis

Anterior superior iliac spine and superior part of notch inferior to it Body and inferior ramus of pubis

Posterior part of medial condyle of tibia; Reflected attachment forms oblique popliteal ligament (to lateral femoral condyle) Upper part of medial surface of shaft of tibia (pes anserinus) Upper medial surface of shaft of tibia (pes anserinus) Upper part of shaft of tibia on medial surface (pes anserinus) Posterior surface of shaft of tibia above soleal line Via tendo calcaneus into posterior surface of calcaneus

Tibial portion of L5, S1, S2 sciatic nerve

Tibial portion of L5, S1, S2 sciatic nerve

Femoral nerve

L2, L3

Obturator nerve

L2, L3

Popliteus

Gastrocnemius

Plantaris

Lateral surface of lateral condyle of femur and lateral meniscus Lateral head from lateral condyle of femur; Medial head above medial condyle and popliteal surface of femur Lateral supracondylar ridge of femur

Tibial nerve

L4, L5, S1

Tibial nerve

S1, S2

Posterior surface of calcaneus

Tibial nerve

S1, S2

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Extension

Rectus femoris

Vastus lateralis

Straight head: anterior inferior iliac spine; Reflected head: ilium above acetabulum Greater trochanter and lateral lip of linea aspera

Quadriceps tendon into patella, then via ligamentum patellae into tubercle of tibia Quadriceps tendon into patella, then via ligamentum patellae into tubercle of tibia Quadriceps tendon into patella, then via ligamentum patellae into tubercle of tibia Quadriceps tendon into patella, then via ligamentum patellae into tubercle of tibia Posterior part of medial condyle of tibia; Reflected attachment forms oblique popliteal ligament (to lateral femoral condyle) Upper part of medial surface of shaft of tibia (pes anserinus) Upper medial surface of shaft of tibia (pes anserinus) Upper part of shaft of tibia on medial surface (pes anserinus) Posterior surface of shaft of tibia above soleal line

Femoral nerve

L2, L3, L4

Femoral nerve

L2, L3, L4

Vastus medialis

Intertrochanteric line and medial lip of linea aspera

Femoral nerve

L2, L3, L4

Vastus intermedius

Anterior and lateral surfaces of femur

Femoral nerve

L2, L3, L4

Medial rotation

Semimembranosus

Ischial tuberosity

Tibial portion of sciatic nerve

L5, S1, S2

Semitendinosus

Ischial tuberosity

Tibial portion of sciatic nerve

L5, S1, S2

Sartorius

Gracilis

Anterior superior iliac spine & superior part of notch inferior to it Body and inferior ramus of pubis

Femoral nerve

L2, L3

Obturator nerve

L2, L3

Lateral surface of lateral condyle of femur and lateral meniscus Long Head: Ischial Lateral side of Biceps femoris Lateral tuberosity head of fibula; (Two heads) rotation Short Head: Tendon is split at Linea aspera of this site by fibular femur, entire length collateral ligament of lateral lip, and of knee lateral supracondylar line *The predominant segmental nerve supply is indicated by boldface type The primary muscles that produce each movement are shown in boldface type Popliteus

Tibial nerve

L4, L5, S1

Long Head: Tibial portion of sciatic nerve Short Head: Common peroneal (fibular) portion of sciatic nerve

L5, S1, S2

29

SUMMARY OF ANKLE (TALOCRUAL) JOINT MOVEMENTS AND MUSCLES PRODUCING THOSE MOVEMENTS
MOVEMENTS MUSCLES ORIGIN INSERTION NERVE SUPPLY Deep peroneal (fibular) nerve SEGMENTAL NERVE ROOTS* L4, L5

Dorsiflexion

Tibialis anterior

Lateral condyle and superior half of lateral surface of tibia and interosseous membrane Lateral condyle of tibia and superior threefourths of medial surface of fibula and interosseous membrane Middle part of anterior surface of fibula and interosseous membrane Inferior third of anterior surface of fibula and interosseous membrane

Medial and inferior surfaces of medial cuneiform and base of first metatarsal bone Extensor expansion of middle and distal phalanges of lateral four toes

Extensor digitorum longus

Deep peroneal (fibular) nerve

L5, S1

Extensor hallucis longus

Dorsal aspect of base of distal phalanx of great toe (hallux)

Deep peroneal (fibular) nerve

L5, S1

Peroneus (Fibularis) tertius

Dorsum of base of fifth metatarsal

Deep peroneal (fibular) nerve

L5, S1

30

Plantar flexion

Gastrocnemius

Soleus

Lateral head from lateral condyle of femur and medial head from above medial condyle and popliteal surface of femur Shafts of tibia and fibula

Via tendo Tibial nerve calcaneus into posterior surface of calcaneus

S1, S2

Plantaris

Peroneus (Fibularis) longus Peroneus (Fibularis) brevis Tibialis posterior

Flexor digitorum longus

Flexor hallucis longus

Lateral supracondylar ridge of femur Head and superior twothirds of lateral surface of fibula Inferior twothirds of lateral surface of fibula Posterior surface of tibia inferior to soleal line and posterior surface of fibula; Interosseous membrane Medial part of posterior surface of tibia inferior to soleal line and by a broad tendon to fibula Inferior twothirds of posterior surface of fibula and inferior part of interosseous membrane

Via tendo Tibial nerve calcaneus into posterior surface of calcaneus Posterior surface Tibial nerve of calcaneus Base of first metatarsal and the medial cuneiform Base of fifth metatarsal bone Tuberosity of navicular; 1st, 2nd, and 3rd cuneiforms, and cuboid; Bases of 2nd, 3rd, and 4th metatarsals Bases of distal phalanges of lateral four toes Superficial peroneal (fibular) nerve Superficial peroneal (fibular) nerve Tibial nerve

S1, S2

S1, S2

L5, S1, S2

L5, S1, S2

L4, L5

Tibial nerve

S2, S3

Base of distal phalanx of big toe

Tibial nerve

S2, S3

*The predominant segmental nerve supply is indicated by boldface type The primary muscles that produce each movement are shown in boldface type

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SUMMARY OF SUBTALAR (TALOCALCANEAL) JOINT MOVEMENTS AND MUSCLES PRODUCING THOSE MOVEMENTS
MOVEMENTS MUSCLES ORIGIN INSERTION NERVE SUPPLY Deep peroneal (fibular) nerve SEGMENTAL NERVE ROOTS* L4, L5

Medial and Lateral condyle and superior half inferior surfaces of lateral surface of medial cuneiform and of tibia and base of first interosseous metatarsal bone membrane Posterior surface Tuberosity of Tibialis navicular; 1st, of tibia inferior posterior to soleal line and 2nd, and 3rd posterior surface cuneiforms, and of fibula; cuboid; Bases of Interosseous 2nd, 3rd, and 4th membrane metatarsals Bases of distal Flexor digitorum Medial part of longus posterior surface phalanges of lateral four toes of tibia inferior to soleal line and by a broad tendon to fibula Base of distal Flexor hallucis Inferior twophalanx of big longus thirds of posterior surface toe of fibula and inferior part of interosseous membrane Base of first Head and Peroneus Eversion metatarsal and superior two(Fibularis) and the medial thirds of lateral longus surface of fibula cuneiform Abduction Base of fifth Inferior twoPeroneus metatarsal bone thirds of lateral (Fibularis) surface of fibula brevis Dorsum of base Inferior third of Peroneus of fifth anterior surface (Fibularis) metatarsal of fibula and tertius interosseous membrane Extensor Extensor Lateral condyle expansion of digitorum longus of tibia and middle and distal superior threefourths of medial phalanges of surface of fibula lateral four toes and interosseous membrane *The predominant segmental nerve supply is indicated by boldface type The primary muscles that produce each movement are shown in boldface type

Inversion and Adduction

Tibialis anterior

Tibial nerve

L4, L5

Tibial nerve

S2, S3

Tibial nerve

S2, S3

L5, S1, S2 Superficial peroneal (fibular) nerve L5, S1, S2 Superficial peroneal (fibular) nerve Deep peroneal L5, S1 (fibular) nerve

Deep peroneal (fibular) nerve

L5, S1

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SUMMARY OF METATARSOPHALANGEAL (MP) AND INTERPHALANGEAL (IP) JOINT MOVEMENTS OF THE TOES & MUSCLES PRODUCING THOSE MOVEMENTS
MOVEMENTS MUSCLES Flexor digitorum longus (MP & IP) Flexor digitorum brevis (MP & IP) ORIGIN Medial part of posterior surface of tibia inferior to soleal line and by a broad tendon to fibula Medial tubercle of calcaneus; Plantar aponeurosis and intermuscular septa INSERTION Bases of distal phalanges of lateral four toes Four tendons to four lateral toesinserted into borders of middle phalanx; tendons perforated by those of flexor digitorum longus Lateral side of base of proximal phalanx of little toe Base of distal phalanx of big toe NERVE SUPPLY Tibial nerve SEGMENTAL NERVE ROOTS*

Flexion

S2, S3

Medial plantar nerve

S2, S3

Flexor digiti minimi brevis (MP) Flexor hallucis longus (MP & IP)

Base of fifth metatarsal bone Inferior two-thirds of posterior surface of fibula and inferior part of interosseous membrane Lateral surfaces of cuboid and lateral cuneiforms; Tibialis posterior insertion

Superficial branch of lateral plantar nerve Tibial nerve

S2, S3

S2, S3

Flexor hallucis brevis (MP)

Lumbricals (MP) (1-4)

Tendons of flexor digitorum longus

Dorsi interossei (MP)(1-4)

Adjacent sides of metatarsal 1-5

Plantar interossei (MP) (1-3) Quadratus plantae (IP)

Inferior surfaces of third, fourth, and fifth metatarsal bones Medial and lateral sides of plantar surface of calcaneus

Medial tendon into medial side of base of proximal phalanx of big toe; lateral tendon into lateral side of base of proximal phalanx of big toe Dorsal extensor expansion; bases of proximal phalanges of lateral four toes Bases of proximal phalanges: 1st - medial side of 2nd toe; 2nd through 4th - lateral sides of 2nd, 3rd, and 4th toes; dorsal extensor expansion Medial side of bases of proximal phalanges of lateral three toes Posterolateral margin of tendons of flexor digitorum longus

Medial plantar nerve

S2, S3

First lumbrical: medial plantar nerve; remainder: lateral plantar nerve Lateral plantar nerve

S2, S3

S2, S3

Lateral plantar nerve

S2, S3

Lateral plantar nerve

S2, S3

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Extension

Extensor digitorum longus (MP & IP)

Extensor digitorum brevis (MP & IP of toes 2-4);

Lateral condyle of tibia and superior three-fourths of medial surface of fibula and interosseous membrane Anterior part of upper surface of calcaneus; Inferior extensor retinaculum

Extensor expansion of middle and distal phalanges of lateral four toes

Deep peroneal (fibular) nerve

L5, S1

By three tendons Deep peroneal that merge into (fibular) nerve the extensor digitorum longus tendons to the second, third, and fourth toes;

L5, S1

Extensor hallucis brevis (MP of big toe) part of extensor digitorum brevis Extensor hallucis longus (MP & IP)

Into the base of the proximal phalanx of big toe

Middle part of anterior surface of fibula and interosseous membrane Tendons of flexor digitorum longus

Dorsal aspect of base of distal phalanx of great toe (hallux)

Deep peroneal (fibular) nerve

L5, S1

Lumbricals (IP) (1-4)

Dorsal extensor expansion; bases of proximal phalanges of lateral four toes

Bases of proximal phalanges: 1st - medial side of 2nd toe; 2nd through 4th - lateral sides of 2nd, 3rd, and 4th toes, and also dorsal extensor expansion

Dorsi interossei (IP) (1-4)

Adjacent sides of metatarsal 1-5

First lumbrical: medial plantar nerve; remainder: lateral plantar nerve Lateral plantar nerve

S2, S3

S2, S3

Plantar interossei (IP) (1-3)

Inferior surfaces of third, fourth, and fifth metatarsal bones

Medial side of bases of proximal phalanges of lateral three toes

Lateral plantar nerve

S2, S3

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Abduction

Dorsi interossei (1-4)

Adjacent sides of metatarsal 1-5

Adduction

Medial and lateral Abductor digiti minimi tubercles of calcaneus; Plantar aponeurosis and intermuscular septa Medial tuberosity of Abductor calcaneus; Flexor hallucis retinaculum and plantar aponeurosis Inferior surfaces of Plantar third, fourth, and interossei fifth metatarsal (1-3) bones Adductor hallucis Oblique Head: Bases of metatarsals 2-4; Transverse Head: Plantar ligaments of metatarsophalangeal joints

Bases of proximal phalanges: 1st - medial side of 2nd toe; 2nd through 4th lateral sides of 2nd, 3rd, and 4th toes, and also dorsal extensor expansion Lateral side of base of proximal phalanx of fifth toe Medial side of base of proximal phalanx of big toe Medial side of bases of proximal phalanges of lateral three toes Tendons of both heads attach to lateral side of base of proximal phalanx of big toe

Lateral plantar nerve

S2, S3

Lateral plantar nerve

S2, S3

Medial plantar nerve

S2, S3

Lateral plantar nerve

S2, S3

Deep branch of lateral plantar nerve

S2, S3

*The predominant segmental nerve supply is indicated by boldface type The primary muscles that produce each movement are shown in boldface type

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SUMMARY OF CERVICAL INTERVERTEBRAL, ATLANTO-OCCIPITAL, AND ATLANTOAXIAL JOINT MOVEMENTS AND MUSCLES PRODUCING THOSE MOVEMENTS
MOVEMENTS MUSCLES ORIGIN INSERTION Mastoid process of temporal bone and occipital bone NERVE SUPPLY Spinal part of Cranial nerve XI (spinal accessory nerve) and C2-C3 Anterior rami of cervical nerves (C4-C6) Anterior rami of cervical nerves (C3-C8) Anterior rami of cervical nerves (C6-C8) Ventral primary rami of C2-C6 spinal nerves

Flexion

Sternocleidomastoid Sternal Head: Anterior surface of manubrium of sternum; Clavicular Head: Superior surface of medial third of clavicle Transverse processes of Scalenus anterior third, fourth, fifth, and sixth cervical vertebrae Transverse processes of Scalenus medius upper six cervical vertebrae Transverse processes of Scalenus posterior lower cervical vertebrae Medial part: bodies of Longus colli 3rd thoracic to 5th cervical vertebrae; superolateral part: anterior tubercles of transverse processes of 3rd to 5th cervical vertebrae; inferolateral part: bodies of 1st to 3rd thoracic vertebrae Longus capitis Anterior tubercles of transverse processes of third to sixth cervical vertebrae Base of skull, just anterior to occipital bone Jugular process of occipital bone Deep fascia over pectoralis major and deltoid

First rib

First rib

Second rib

Medial part: bodies of 2nd to 4th cervical vertebrae; superolateral part: the anterior tubercle of the atlas; inferolateral part: the anterior tubercles of the transverse processes of 5th and 6th cervical vertebrae basilar process of Ventral primary occipital bone rami of C1-C3 spinal nerves Anterior surface of lateral mass of C1 vertebral (atlas) Transverse process of C1 vertebral (atlas) Inferior border of body of mandible angle of mouth, skin, and subcutaneous tissues of lower face

Rectus capitis anterior Rectus capitis lateralis Platysma

Branches from loop between C1 and C2 Branches from loop between C1 and C2 Facial nerve (Cranial nerve VII) - cervical branch

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Extension

Iliocostalis cervicis Longissimus cervicis Longissimus capitis Spinalis cervicis (often absent) Smallest and thinnest of erector spinae Spinalis capitis (blends with semispinalis capitis) Semispinalis capitis Semispinalis cervicis Splenius capitis

Angles of 3-6 ribs Transverse processes of T1-T5 vertebrae Transverse processes of T1-T5 and articular processes of C4-C7 Inferior part of nuchal ligament, spinous processes of C7-T2 vertebrae Articular processes of C4-C6 vertebrae Transverse processes of C7-T6 vertebrae Arises from transverse processes of C7 and T1-T6 Arises from transverse processes of T1-T5 vertebrae Inferior part of nuchal ligament, spinous processes of C7-T3 vertebrae, & supraspinous ligament Spinous processes of T3-T6 vertebrae External occipital protuberance and medial 1/3 of superior nuchal line, ligamentum nuchae, and spinous process of C7 Transverse process of atlas spinous process of axis From posterior tubercle of atlas Transverse processes of T1-T3, and articular processes of C4-C7 vertebrae Arise from transverse processes of cervical vertebrae

Posterior tubercles of transverse processes of C4-C6 vertebrae Transverse processes and articular processes of C2-C6 vertebrae Mastoid process of temporal bone

Dorsal rami of spinal nerves (C4-T3) Dorsal rami of spinal nerves (C3-T3 Dorsal rami of spinal nerves (C3-C8) Dorsal rami of spinal nerves (C4-C8)

Spinous processes of C2 vertebrae; occasionally spinous processes of C3 and C4 vertebrae

Occipit (back of head) between superior and inferior nuchal lines of occipital bone Fibers run superomedially to occipital bone, spanning 4-6 segments Fibers run superomedially to spinous processes of C2-C5, spanning 4-6 segments Fibers run superolaterally to mastoid process of temporal bone and inferior to lateral third of superior nuchal line of occipital bone Posterior tubercles of transverse processes of C1-C3 or C4 vertebrae Lateral third of posterior clavicle

Dorsal rami of spinal nerves (C3-T1)

Dorsal rami of spinal nerves (C2-T1) Dorsal rami of spinal nerves (C2-T5) Dorsal rami of spinal nerves (C3-C6)

Splenius cervicis Trapezius (Upper Fibers)

Dorsal rami of spinal nerves (C4-C8) XI cranial nerve (Spinal part of accessory nerve);

C3, C4
lateral third of inferior nuchal line middle of inferior nuchal line of occipital bone medial third of inferior nuchal line of occipital bone Fibers pass superomedially to spinous processes of vertebrae above, spanning 2-4 segments Pass superomedially to attach to junction of lamina and transverse processes, or spinous processes of vertebrae above their origin, spanning 1-2 segments Superior part of medial border of scapula near superior angle Inferior surfaces of spinous processes of vertebrae superior to vertebrae of origin Transverse processes of adjacent vertebrae dorsal branch of C1 (suboccipital) dorsal branch of C1 (suboccipital) dorsal branch of C1 (suboccipital) Dorsal rami of spinal nerves (C4-T1) Dorsal rami of spinal nerves (C3-C8)

Obliquus capitis superior Rectus capitis posterior major Rectus capitis posterior minor Multifidi cervicis

Rotatores cervicis

Levator scapulae

Transverse processes of C1-C4 vertebrae Superior surfaces of spinous processes of C1-T1 Transverse processes of cervical vertebrae

Interspinales cervicis Intertransversarii cervicis

C3 and C4; dorsal scapular nerve from C5 root Dorsal rami of spinal nerves (C3-C8)
Dorsal/ventral rami of spinal nerves (C3-C8)

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Lateral Flexion*

Iliocostalis cervicis

Angles of 3-6 ribs

Longissimus cervicis

Transverse processes of T1-T5 vertebrae Transverse processes of T1-T5 and C4-C7 articular processes Articular processes of C4-C6 vertebrae Transverse processes of C7-T6 (T7) vertebrae Arises from transverse processes of C7 and T1-T6 Arises from transverse processes of T1-T5 vertebrae Jugular process of occipital bone Inferior part of nuchal ligament, spinous processes of C7-T3 or T4 vertebrae, and supraspinous ligament Spinous processes of T3-T6 vertebrae External occipital protuberance and medial 1/3 of superior nuchal line, ligamentum nuchae, and spinous process of C7 Transverse process of atlas Sternal Head: Anterior surface of manubrium of sternum; Clavicular Head: Superior surface of medial third of clavicle Transverse processes of third, fourth, fifth, and sixth cervical vertebrae Transverse processes of upper six cervical vertebrae Transverse processes of lower cervical vertebrae

Longissimus capitis

Posterior tubercles of transverse processes of C4C6 vertebrae Transverse processes and articular processes of C2C6 vertebrae Mastoid process of temporal bone Occipit (back of head) between superior and inferior nuchal lines of occipital bone Fibers run superomedially to occipital bone, spanning 4-6 segments Fibers run superomedially to spinous processes of C2C5, spanning 4-6 segments Transverse process of C1 vertebral (atlas) Fibers run superolaterally to mastoid process of temporal bone and inferior to lateral third of superior nuchal line of occipital bone Posterior tubercles of transverse processes of C1C3 or C4 vertebrae Lateral third of posterior clavicle

Spinalis capitis (blends with semispinalis capitis)

Dorsal rami of spinal nerves (C4-T3) Dorsal rami of spinal nerves (C3-T3) Dorsal rami of spinal nerves (C3-C8) Dorsal rami of spinal nerves (C3-T1) Dorsal rami of spinal nerves (C2-T1) Dorsal rami of spinal nerves (C2-T5) Branches from loop between C1 and C2 Dorsal rami of spinal nerves (C3-C6)

Semispinalis capitis

Semispinalis cervicis

Rectus capitis lateralis Splenius capitis

Splenius cervicis

Trapezius (Upper Fibers)

Dorsal rami of spinal nerves (C4-C8) XI cranial nerve (Spinal part of accessory nerve);

C3, C4

Obliquus capitis superior

lateral third of inferior nuchal line Mastoid process of temporal bone and occipital bone

Sternocleidomastoid

dorsal branch of first cervical (suboccipital) Spinal part of Cranial nerve XI (spinal accessory nerve) and C2-C3

Scalenus anterior

First rib

Anterior rami of cervical nerves (C4-C6) Anterior rami of cervical nerves (C3-C8) Anterior rami of cervical nerves (C6-C8)

Scalenus medius

First rib

Scalenus posterior

Second rib

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Spinalis cervicis (often absent) Smallest and thinnest of the erector spinae Multifidi Cervicis Inferior part of nuchal ligament, spinous processes of C7-T2 vertebrae Transverse processes of T1-T3, and articular processes of C4-C7 vertebrae Arise from transverse processes of cervical vertebrae Spinous processes of C2 vertebrae; occasionally spinous processes of C3 and C4 vertebrae Fibers pass superomedially to spinous processes of vertebrae above, spanning 2-4 segments Pass superomedially to attach to junction of lamina and transverse processes, or spinous processes of vertebrae above their origin, spanning 1-2 segments Transverse processes of adjacent vertebrae Transverse process of the atlas middle of inferior nuchal line of occipital bone medial third of inferior nuchal line of occipital bone Pass inferolaterally and insert on rib between its tubercle and angle Superior part of medial border of scapula near superior angle Medial part: bodies of 2nd to 4th cervical vertebrae; superolateral part: the anterior tubercle of the atlas; inferolateral part: the anterior tubercles of the transverse processes of 5th and 6th cervical vertebrae Dorsal rami of spinal nerves (C4-C8) Dorsal rami of spinal nerves (C4-T1) Dorsal rami of spinal nerves (C3-C8)

Rotatores Cervicis

Intertransversarii cervicis

Transverse processes of cervical vertebrae Spinous process of axis spinous process of axis From posterior tubercle of atlas Tips of transverse processes of C7 and T1-T11 vertebrae Transverse processes of C1-C4 vertebrae medial part: bodies of 3rd thoracic to 5th cervical vertebrae; superolateral part: anterior tubercles of transverse processes of 3rd to 5th cervical vertebrae;; inferolateral part: bodies of 1st to 3rd thoracic vertebrae anterior tubercles of transverse processes of third to sixth cervical vertebrae

Obliquus capitis inferior Rectus capitis posterior major Rectus capitis posterior minor Levatores costarum

Dorsal and ventral rami of spinal nerves (C3-C8) dorsal branch of C1 (suboccipital) dorsal branch of C1 (suboccipital) dorsal branch of C1 (suboccipital) Dorsal rami of C8-T11 spinal nerves C3 and C4; dorsal scapular nerve from C5 root Ventral primary rami of C2-C6 spinal nerves

Levator scapulae

Longus colli

Longus capitis

basilar process of occipital bone

Ventral primary rami of C1-C3 spinal nerves

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Rotation

Longissimus capitis

**

Splenius capitis**

Splenius cervicis**

Transverse processes of T1-T5 vertebrae and articular processes of C4-C7 vertebrae Inferior part of nuchal ligament, spinous processes of C7-T3 or T4 vertebrae, and supraspinous ligament Spinous processes of T3-T6 vertebrae Spinous process of axis spinous process of axis From posterior tubercle of atlas Sternal Head: Anterior surface of manubrium of sternum; Clavicular Head: Superior surface of medial third of clavicle
External occipital protuberance and medial 1/3 of superior nuchal line, ligamentum nuchae, and spinous process of C7 Arises from transverse processes of C7 and T1-T6 Arises from transverse processes of T1-T5 vertebrae

Mastoid process of temporal bone

Dorsal rami of spinal nerves (C3-C8)

Obliquus capitis inferior** Rectus capitis posterior major** Rectus capitis posterior minor** Sternocleidomastoid***

Fibers run superolaterally to mastoid process of temporal bone and inferior to lateral third of superior nuchal line of occipital bone Posterior tubercles of transverse processes of C1-C3 or C4 vertebrae Transverse process of the atlas middle of inferior nuchal line of occipital bone medial third of inferior nuchal line of occipital bone Mastoid process of temporal bone and occipital bone

Dorsal rami of spinal nerves (C3-C6)

Dorsal rami of spinal nerves (C4-C8) dorsal branch of C1 (suboccipital) dorsal branch of C1 (suboccipital) dorsal branch of C1 (suboccipital) Spinal part of Cranial nerve XI (spinal accessory nerve) and C2-C3

Trapezius (Upper Fibers)***

Lateral third of posterior clavicle

XI cranial nerve (Spinal part of accessory nerve); C3, C4

Semispinalis capitis*** Semispinalis cervicis*** Scalenus anterior***

Fibers run superomedially to occipital bone, spanning 4-6 segments Fibers run superomedially to spinous processes of C2C5, spanning 4-6 segments

Scalenus medius***

Transverse processes of third, fourth, fifth, and sixth cervical vertebrae Transverse processes of upper six cervical vertebrae

First rib

Dorsal rami of spinal nerves (C2-T1) Dorsal rami of spinal nerves (C2-T5) Anterior rami of cervical nerves (C4-C6) Anterior rami of cervical nerves (C3-C8)

First rib

Scalenus posterior

***

Rotatores cervicis***

Transverse processes of lower cervical vertebrae Arise from transverse processes of cervical vertebrae

Second rib

40 Anterior rami of cervical nerves (C6-C8)

Dorsal rami of spinal nerves (C3-C8)

Pass superomedially to attach to junction of lamina and transverse processes, or spinous processes of vertebrae above their origin, spanning 1-2 segments

Multifidi cervicis***

Transverse processes of T1-T3, and articular processes of C4-C7 vertebrae medial part: bodies of 3rd thoracic to 5th cervical vertebrae; superolateral part: anterior tubercles of transverse processes of 3rd to 5th cervical vertebrae;; inferolateral part: bodies of 1st to 3rd thoracic vertebrae anterior tubercles of transverse processes of third to sixth cervical vertebrae

Longus colli***

Longus capitis**

Fibers pass superomedially to spinous processes of vertebrae above, spanning 2-4 segments Medial part: bodies of 2nd to 4th cervical vertebrae; superolateral part: the anterior tubercle of the atlas; inferolateral part: the anterior tubercles of the transverse processes of 5th and 6th cervical vertebrae basilar process of occipital bone

Dorsal rami of spinal nerves (C4-T1)

Ventral primary rami of C2-C6 spinal nerves

Ventral primary rami of C1-C3 spinal nerves

*Unilateral action from flexor or extensor paraspinal muscles results in ipsilateral lateral flexion **Ipsilateral Rotation ***Contralateral Rotation The primary muscles that produce each movement are shown in boldface type

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SUMMARY OF THORACIC AND LUMBAR (THORACOLUMBAR) INTERVERTEBRAL JOINT MOVEMENTS AND MUSCLES PRODUCING THOSE MOVEMENTS
MOVEMENTS

Flexion

MUSCLES Rectus abdominis

ORIGIN Symphysis pubis and pubic crest

External oblique

External surfaces of lower eight ribs (5th-12th ribs)

Internal oblique

Thoracolumbar fascia, anterior two-thirds of iliac crest, lateral half of inguinal ligament Transverse processes, bodies, and intervertebral discs of second through fifth lumbar vertebrae Transverse processes, bodies, and intervertebral discs of twelfth thoracic and first lumbar vertebrae

Psoas major

INSERTION Fifth, sixth, and seventh costal cartilages and xiphoid process Xiphoid process, linea alba, pubic crest, pubic tubercle, anterior half of iliac crest Lower three ribs and costal cartilages, xiphoid process, linea alba, symphysis pubis With iliacus into lesser trochanter of femur

NERVE SUPPLY Lower six thoracic nerves (T7-T12)

Lower six thoracic nerves (T7-T12); Iliohypogastric and ilioinguinal nerves (L1) Lower six thoracic nerves (T7-T12); Iliohypogastric and ilioinguinal nerves (L1) Lumbar plexus (L1, L2, L3)

Psoas minor

With iliacus into lesser trochanter of femur

Lumbar plexus (L1, L2)

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Extension

Iliocostalis lumborum

Iliocostalis thoracis Longissimus thoracis

Common origin of erector spinae, which includes posterior sacrum, iliac crest, sacrotuberous ligament, dorsal sacroiliac ligament, spinous and transverse processes of T11-L5 vertebrae, and supraspinous ligament. Angles of 6-12 ribs

Angles of lower 6-12 ribs

Dorsal rami of spinal nerves (L1-L5)

Spinalis thoracis

Common origin of erector spine, also transverse processes and accessory processes of L1-L5 vertebrae, and middle layer of thoracolumbar fascia Spinous processes of T11-L2 vertebrae Arises from transverse processes of thoracic vertebrae Arise from posterior sacrum and ilium (PSIS and adjacent crest), aponeurosis of erector spinae, sacroiliac ligaments, and transverse processes of T1-L5; best developed in lumbar region Arise from transverse processes of thoracolumbar vertebrae; are best developed in thoracic region

Angles of ribs 1-6, transverse processes of C7 vertebrae Transverse processes of T1-T12 vertebrae between tubercules and angles of lower 9-10 ribs

Dorsal rami of spinal nerves (T1-T12) Dorsal rami of spinal nerves (T1-L1)

Semispinalis thoracis

Multifidi thoracis and lumborum

Spinous processes of T1T4 vertebrae, sometimes down to T8 Fibers run superomedially to spinous processes in thoracic regions, spanning 4-6 segments Fibers pass superomedially to spinous processes of vertebrae above, spanning 2-4 segments

Dorsal rami of spinal nerves (T1-T12) Dorsal rami of spinal nerves (T1-T12) Dorsal rami of spinal nerves (T1-L5)

Rotatores thoracis and lumborum

Quadratus lumborum

Iliolumbar ligament and internal lip of iliac crest

Interspinales thoracis and lumborum Intertransversarii throacis and lumborum

Superior surfaces of spinous processes of thoracic and lumbar vertebrae Transverse processes of T11-L1

Pass superomedially to attach to junction of lamina and transverse processes, or spinous processes of vertebrae above their origin, spanning 1-2 segments Tips of transverse processes of lumbar vertebrae; Medial half of inferior border of twelfth rib Inferior surfaces of spinous processes of vertebrae superior to vertebrae of origin Transverse processes of adjacent vertebrae T10T12

Dorsal rami of spinal nerves (T1-L5)

Ventral Branches of T12; Lumbar plexus (L1-L4)

Dorsal rami of spinal nerves (T1-L4)

Dorsal and ventral rami of spinal nerves (T12-L3)

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Lateral Flexion*

External oblique

External surfaces of lower eight ribs (5th-12th ribs)

Xiphoid process, linea alba, pubic crest, pubic tubercle, anterior half of iliac crest

Internal oblique

Thoracolumbar fascia, anterior two-thirds of iliac crest, lateral half of inguinal ligament

Lower three ribs and costal cartilages, xiphoid process, linea alba, symphysis pubis

Quadratus lumborum Iliocostalis lumborum

Iliocostalis thoracis Longissimus thoracis

Iliolumbar ligament iliac crest, tips of transverse processes of lower lumbar vertebrae posterior sacrum, iliac crest, sacrotuberous ligament, dorsal sacroiliac ligament, spinous processes of transverse processes T11-L5 vertebrae, and supraspinous ligament. Angles of 6-12 ribs

Twelfth rib

Angles of lower 6-12 ribs

Lower six thoracic nerves (T7-T12); Iliohypogastric and ilioinguinal nerves (L1) Lower six thoracic nerves (T7-T12); Iliohypogastric and ilioinguinal nerves (L1) Ventral Branches of T12; Lumbar plexus (L1-L4) Dorsal rami of spinal nerves (L1-L5)

Angles of ribs 1-6, transverse processes of C7 vertebrae Transverse processes of Transverse processes of T1T12 vertebrae between tubercules and angles of lower 9-10 ribs Spinous processes of T1-T4 vertebrae; sometimes down to T8 Fibers run superomedially to occipital bone and spinous processes in thoracic and cervical regions, spanning 4-6 segments Fibers pass superomedially to spinous processes of vertebrae above, spanning 2-4 segments

Spinalis thoracis

Common origin of erector spine, also transverse processes and accessory processes of L1-L5 vertebrae, and middle layer of thoracolumbar fascia Spinous processes of T11-L2 vertebrae Arises from transverse processes of thoracic vertebrae

Dorsal rami of spinal nerves (T1-T12) Dorsal rami of spinal nerves (T1-L1)

Dorsal rami of spinal nerves (T1-T12) Dorsal rami of spinal nerves (T1-T12)

Semispinalis thoracis

Multifidi thoracis and lumborum

Rotatores thoracis and lumborum

Arise from posterior sacrum and ilium (PSIS and adjacent crest), aponeurosis of erector spinae, sacroiliac ligaments, and transverse processes of T1-L5; best developed in lumbar region Arise from transverse processes of thoracolumbar vertebrae; are best developed in thoracic region

Dorsal rami of spinal nerves (T1-L5)

Rectus abdominis

Symphysis pubis and pubic crest

Intertransversarii throacis and lumborum Levatores costarum Psoas major and minor

Transverse processes of T11-L1

Pass superomedially to attach to junction of lamina and transverse processes, or spinous processes of vertebrae above their origin, spanning 1-2 segments Fifth, sixth, and seventh costal cartilages and xiphoid process Transverse processes of adjacent vertebrae T10-T12 Pass inferolaterally and insert on rib between its tubercle and angle With iliacus into lesser trochanter of femur

Dorsal rami of spinal nerves (T1-L5)

Lower six thoracic nerves (T7-T12) Dorsal and ventral rami of spinal nerves (T12-L3) Dorsal rami of C8-T11 spinal nerves Lumbar plexus (L1, L2, L3)

Tips of transverse processes of C7 and T1-T11 vertebrae Transverse processes, bodies, and intervertebral discs of T12 and L1-L5

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Rotation*

External oblique***

External surfaces of lower eight ribs (5th-12th ribs)

Xiphoid process, linea alba, pubic crest, pubic tubercle, anterior half of iliac crest Lower three ribs and costal cartilages, xiphoid process, linea alba, symphysis pubis Fibers run superomedially to occipital bone and spinous processes in thoracic and cervical regions, spanning 4-6 segments Fibers pass superomedially to spinous processes of vertebrae above, spanning 2-4 segments

Internal oblique**

Thoracolumbar fascia, anterior two-thirds of iliac crest, lateral half of inguinal ligament Arises from transverse processes of thoracic vertebrae

Semispinalis thoracis***

Lower six thoracic nerves (T7-T12); Iliohypogastric and ilioinguinal nerves (L1) Lower six thoracic nerves (T7-T12); Iliohypogastric and ilioinguinal nerves (L1) Dorsal rami of spinal nerves (T1-T12)

Multifidi thoracis and lumborum ***

Rotatores thoracis and lumborum***

Arise from posterior sacrum and ilium (PSIS and adjacent crest), aponeurosis of erector spinae, sacroiliac ligaments, and transverse processes of T1-L5; best developed in lumbar region Arise from transverse processes of thoracolumbar vertebrae; are best developed in thoracic region

Dorsal rami of spinal nerves (T1-L5)

Iliocostalis lumborum**

posterior sacrum, iliac crest, sacrotuberous ligament, dorsal sacroiliac ligament, spinous processes of transverse processes T11-L5 vertebrae, and supraspinous ligament.

Pass superomedially to attach to junction of lamina and transverse processes, or spinous processes of vertebrae above their origin, spanning 1-2 segments Angles of lower 6-12 ribs

Dorsal rami of spinal nerves (T1-L5)

Dorsal rami of spinal nerves (L1-L5)

*Unilateral action from flexor or extensor paraspinal muscles **Ipsilateral Rotation ***Contralateral Rotation The primary muscles that produce each movement are shown in boldface type