Because learning changes everything.

Chapter 10

The Muscular System

ANATOMY & PHYSIOLOGY

The Unity of Form and Function
NINTH EDITION
KENNETH S. SALADIN

© 2021 McGraw Hill. All rights reserved. Authorized only for instructor use in the classroom.
No reproduction or further distribution permitted without the prior written consent of McGraw Hill.
 Introduction

Muscles constitute nearly half

of the body’s weight and are of
central interest in several fields
of health care and fitness

Figure 10.5a

© McGraw Hill 2
 10.1 Structural and Functional Organization of Muscles 1

Expected Learning Outcomes:

• Describe the various functions of muscular tissue.
• Describe the connective tissue components of a muscle
and their relationship to the internal organization of a
muscle and compartmentalization of muscle groups.
• Relate muscle fascicles to the shapes and relative
strengths of muscles.
• Name the types of muscle–bone attachments and explain
the shortcoming of calling their attachments origins and
insertions.

© McGraw Hill 3
 Structural and Functional Organization of Muscles 2

Distinguish between intrinsic and extrinsic muscles.

Describe the ways muscles work in groups to aid, oppose,

and moderate each other’s actions.

Describe in general terms the nerve and blood supply to

skeletal muscles.

Explain how the Latin names of muscles aid in visualizing

and remembering them.

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 The Functions of Muscles 1

Muscle functions include: movement, stability, control of

openings, heat production, and glycemic control
Movement
• Move from place to place
• Move body parts
• Move body contents in breathing, circulation, and digestion
• In communication:
• Speech
• Writing
• Facial expressions
• Other nonverbal communications

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 The Functions of Muscles 2

Stability
• Maintain posture by preventing unwanted movements
• Antigravity muscles: prevent us from falling over
• Stabilize joints by maintaining tension
Control of openings and passageways
• Sphincters: internal muscular rings that control the
movement of food, blood, and other materials within body
Heat production by skeletal muscles
• As much as 85% of our body heat
Glycemic control
• Muscles absorb and store glucose which helps regulate
blood sugar concentration within normal range
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 Structural and Functional Organization of Muscles 3

About 600 human skeletal muscles

Constitute about half of our body weight
Three kinds of muscle tissue
• Skeletal, cardiac, smooth
Specialized for one major purpose:
• Converting the chemical energy in ATP into the
mechanical energy of motion
Myology—the study of the muscular system

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 Connective Tissues of a Muscle 1

Figure 10.1a

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 Muscle Connective Tissues, Fascicles, and
Compartments 1

Endomysium
• Thin sleeve of loose connective tissue around each fiber
• Allows room for capillaries and nerve fibers
• Provides chemical environment for muscle fiber
Perimysium
• Thicker layer of connective tissue that wraps fascicles
• Fascicles: bundles of muscle fibers wrapped together
• Carries nerves, blood vessels, and stretch receptors

© McGraw Hill 9
 Muscle Connective Tissues, Fascicles,
and Compartments 2

Epimysium
• Fibrous sheath surrounding entire muscle
• Outer surface grades into fascia; inner surface projections
form perimysium
Fascia
• Sheet of connective tissue that separates neighboring
muscles or muscle groups from each other and the
subcutaneous tissue

© McGraw Hill 10
 Connective Tissues of a Muscle 2

Figure 10.1c

Access the text alternative for slide images.

© McGraw Hill c: Victor Eroschenko 11

 Classification of Muscles According to Fascicle
Orientation 1

Figure 10.2

© McGraw Hill 12
 Classification of Muscles According to Fascicle
Orientation 2

Strength of a muscle and the direction of its pull are

determined partly by the orientation of its fascicles
• Fusiform muscles
• Thick in the middle and tapered at each end
• Parallel muscles
• Uniform width and parallel fascicles
• Triangular (convergent) muscles
• Broad at one end and narrow at the other
• Circular muscles (sphincters)
• Form rings around body openings

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 Classification of Muscles According to Fascicle
Orientation 3

Pennate muscles
• Feather shaped

• Three types of pennate muscles:

• Unipennate—fasciles approach tendon from one side

• Bipennate—fascicles approach tendon from both sides

• Multipennate—bunches of feathers converge to single point

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 Muscle Compartments 1

Muscle compartment
• A group of functionally related muscles enclosed by fascia
• Also contains nerves and blood vessels that supply the
muscle group
Intermuscular septa are very thick fascia that separate one
compartment from another

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 Muscle Compartments 2

Figure 10.3

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 Muscle Attachments 1

Indirect attachment to bone

• Tendons connect muscle to bone
• Collagen fibers of the endo-, peri-, and epimysium continue into the
tendon and from there into periosteum and matrix of bone
• Aponeurosis—tendon is a broad, flat sheet (palmar aponeurosis)
• Retinaculum—connective tissue band that tendons from separate
muscles pass under
Direct (fleshy) attachment to bone
• Little separation between muscle and bone
• Muscle seems to emerge directly from bone

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 Muscle Attachments 2

Used to be called origin (stationary) and insertion (moving).

But this is often not accurate
Some anatomists prefer nontraditional descriptions of
attachments by proximal versus distal or superior versus
inferior
Some muscles attach not on bone but on the fascia or
tendon of another muscle or on collagen fibers of the dermis
• Example: many facial muscles attach to the skin

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 Intrinsic and Extrinsic Muscles

Intrinsic muscle
• Entirely contained within a region, such as the hand

Extrinsic muscle
• Acts on a designated region but has attachment elsewhere
• Finger movements: extrinsic muscles in the forearm

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 Functional Groups of Muscles 1

Action
• Effect produced by a muscle to produce or prevent
movement
• Four categories of muscle action:
• Prime mover

• Synergist

• Antagonist

• Fixator

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 Functional Groups of Muscles 2

Prime mover (agonist)

• Muscle producing most of force during a particular action
Synergist
• Muscle that aids the prime mover
• May contribute additional force, modify the direction of movement, or stabilize a
nearby joint
Antagonist
• Muscle that opposes the action of the prime mover
• Contracts to prevent excessive movement or relaxes to give prime mover control
over an action
• Antagonistic pairs—muscles that act on opposite sides of a joint

Fixator
• Muscle that prevents movement of bone

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 Synergistic and Antagonistic Muscle Pairs

Figure 10.4

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 Muscle Innervation 1

Innervation of a muscle
• Refers to the identity of the nerve that stimulates it
• Knowing innervation enables diagnosis of nerve, spinal
cord, and brainstem injuries from muscle tests
Spinal nerves arise from the spinal cord
• Emerge through intervertebral foramina
• Immediately branch into posterior and anterior rami
• Innervate muscles below the neck
• Plexus: web-like network of spinal nerves adjacent to the
vertebral column

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 Muscle Innervation 2

Cranial nerves arise from the base of the brain

• Emerge through skull foramina
• Innervate the muscles of the head and neck
• Numbered CN I to CN XII

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 Blood Supply

Muscular system receives about 1.24 L of blood per minute

at rest (one-quarter of the blood pumped by the heart)
During heavy exercise, total cardiac output rises and the
muscular system’s share is more than three-quarters (11.6
L/min)
Capillaries branch extensively through the endomysium to
reach every muscle fiber

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 How Muscles Are Named

Latin names
• Describe distinctive aspects of the structure, location, or
action of a muscle
• Examples:
• Depressor labii inferioris
• Flexor digiti minimi brevis
• Footnotes throughout chapters show interpreted names of
muscles
• Pronunciation of muscles available online at
www.aprevealed.com

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 The Muscular System

Figure 10.5 Figure 10.6

© McGraw Hill 27
 A Learning Strategy

Examine models, cadavers, dissected animals, or a

photographic atlas
Palpate muscles on yourself if possible
Locate attachments of muscles on articulated skeleton
Study derivation of each muscle name
• Usually describes the muscle’s location, appearance,
attachments, or action
Say the names aloud to yourself or study partner, and spell
them correctly

© McGraw Hill 28
 10.2 Muscles of the Head and Neck

Expected Learning Outcomes:

• Name and locate the muscles that produce facial
expression.
• Name and locate the muscles used for chewing and
swallowing.
• Name and locate the neck muscles that move the head.
• Identify the attachments, action, and innervation of these
muscles.

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 Muscles of Facial Expression 1

Muscles of facial expression attach to the dermis and

subcutaneous tissues
• Tense the skin and produce facial expressions
• Innervated by facial nerve (CN VII)
• Paralysis causes face to sag
• Found in scalp, forehead, around the eyes, nose, and
mouth, and in the neck

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 Muscles of Facial Expression 2

Figure 10.9a

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 Muscles of Facial Expression 3

Figure 10.9b

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 Muscles of Chewing and Swallowing 1

Extrinsic muscles of the tongue

• Tongue is very agile organ
• Pushes food between molars for chewing (mastication)
• Forces food into the pharynx for swallowing (deglutition)
• Crucial importance to speech

Intrinsic muscles of tongue

• Vertical, transverse, and longitudinal fascicles

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 Muscles of the Tongue and Pharynx 1

Figure 10.10

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 Muscles of Chewing and Swallowing 2

Four pairs of muscles produce biting and chewing

movements of the mandible
• Depression: to open mouth
• Elevation: biting and grinding
• Protraction: incisors can cut
• Retraction: make rear teeth meet
• Lateral and medial excursion: grind food
Temporalis, masseter, medial pterygoid, and lateral pterygoid
Innervated by mandibular nerve, a branch of the trigeminal
(CN V)

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 Muscles of Chewing

Figure 10.11

© McGraw Hill 36
 Muscles of Chewing and Swallowing 3

Suprahyoid group
• Actions involve chewing, swallowing, and vocalizing
• Digastric—opens mouth widely

• Geniohyoid—depresses mandible

• Mylohyoid—elevates floor of mouth at beginning of swallowing

• Stylohyoid—elevates hyoid

© McGraw Hill 37
 Muscles of the Neck 1

Figure 10.12a

© McGraw Hill 38
 Muscles of Chewing and Swallowing 4

Infrahyoid group
• Fix hyoid bone from below, allowing suprahyoid muscles to
open mouth
• Omohyoid—depresses hyoid after elevation

• Sternohyoid—depresses hyoid after elevation

• Thyrohyoid—depresses hyoid and elevates larynx

• Sternothyroid—depresses larynx after elevation

© McGraw Hill 39
 Muscles of the Neck 2

Figure 10.12b

© McGraw Hill 40
 Muscles of Chewing and Swallowing 5

Pharynx
• Three pairs pharyngeal constrictors
• Encircle pharynx forming a muscular funnel

• During swallowing, drive food into the esophagus

© McGraw Hill 41
 Muscles of the Tongue and Pharynx 2

Figure 10.10

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 Muscles Acting on the Head 1

Attachments:
• Inferior attachments on vertebral column, thoracic cage,
and pectoral girdle
• Superior attachments on the cranial bones
Actions:
• Flexion (tipping head forward)
• Extension (holding the head erect)
• Lateral flexion (tipping head to one side)
• Rotation (turning the head to the left and right)

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 Muscles Acting on the Head 2

Neck flexors
• Sternocleidomastoid
• Scalenes

Neck extensors
• Trapezius
• Splenius capitis
• Semispinalis capitis

Figure 10.13

© McGraw Hill Rebecca Gray/Don Kincaid/McGraw-Hill Education 44

 Muscles Acting on the Head 3

Contralateral movement
• Movement of the head toward the opposite side

Ipsilateral movement
• Movement of the head toward the same side

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 10.3 Muscles of the Trunk

Expected Learning Outcomes:

• Name and locate the muscles of respiration and explain
how they affect airflow and abdominal pressure.
• Name and locate the muscles of the abdominal wall, back,
and pelvic floor.
• Identify the skeletal attachments, action, and innervation
of these muscles.

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 Muscles of the Trunk

Four functional groups:

• Muscles of respiration
• Muscles that support abdominal wall
• Movement of vertebral column
• Muscles that support the pelvic floor

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 Muscles of Respiration 1

Breathing requires the use of muscles enclosing thoracic

cavity
• Diaphragm
• External intercostals
• Internal intercostals

Inspiration—air intake
Expiration—expelling air

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 Muscles of Respiration 2

Other muscles that contribute to breathing:

• Neck muscles:
• Sternocleidomastoid
• Scalenes
• Chest muscles:
• Pectoralis major
• Serratus anterior
• Back muscles:
• Latissimus dorsi
• Abdominal muscles:
• Internal and external obliques
• Transverse abdominis
• Anal muscles
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 Muscles of Respiration 3

Diaphragm
• Muscular dome between thoracic and abdominal cavities
• Muscle fascicles extend to a fibrous central tendon

• Contraction flattens diaphragm

• Enlarges thoracic cavity (inspiration)

• Diaphragm rises when it relaxes

• Shrinks the thoracic cavity (expiration)

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 Muscles of Respiration 4

Figure 10.14b

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 Muscles of Respiration 5

External intercostals
• Elevate ribs
• Expand thoracic cavity
• Create partial vacuum causing inflow of air
Internal intercostals
• Depresses and retracts ribs
• Compresses thoracic cavity
• Expelling air
Innermost intercostals
• Same action as internal intercostals
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 Muscles of Respiration 6

Figure 10.14a

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 Muscles of the Anterior Abdominal Wall 1

External abdominal oblique

• External layer of lateral abdominal muscles
• Supports viscera, aids in breathing, unilateral contraction
causes contralateral rotation of waist
Internal abdominal oblique
• Intermediate layer of lateral abdominal muscles
• Unilateral contraction causes ipsilateral rotation of waist
• Aponeuroses
• Tendons of oblique and transverse muscles
• Broad, fibrous sheets

© McGraw Hill 54
 Muscles of the Anterior Abdominal Wall 2

Transverse abdominal
• Deepest of lateral abdominal muscles
• Horizontal fibers
• Compresses abdominal contents
• Contributes to movements of vertebral column

© McGraw Hill 55
 Muscles of the Anterior Abdominal Wall 3

Figure 10.16b

© McGraw Hill 56
 Muscles of the Anterior Abdominal Wall 4

Rectus abdominis
• Flexes lumbar region of vertebral column

• Produces forward bending at the waist

• Extends from sternum to pubis

• Rectus sheath encloses muscle

• Three transverse tendinous intersections divide rectus

abdominis into segments, sometimes called a “six pack”

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 Muscles of the Anterior Abdominal Wall 5

Figure 10.16a

© McGraw Hill 58
 Muscles of the Back 1

Actions involve:
• Extension, rotation, and lateral flexion of vertebral column
• Upper limb movement

Most prominent superficial back muscles:

• Latissimus dorsi
• Trapezius

© McGraw Hill 59
 Neck, Back, and Gluteal Muscles

Figure 10.18

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 Muscles of the Back 2

Deep muscles of the back

• Erector spinae
• Iliocostalis, longissimus, spinalis
• From cranium to sacrum
• Extension and lateral flexion of vertebral column
• Semispinalis thoracis
• Extension and contralateral rotation of vertebral column
• Quadratus lumborum
• Aids respiration
• Ipsilateral flexion of lumbar vertebral column
• Multifidus
• Stabilizes adjacent vertebrae
• Maintains posture
© McGraw Hill 61
 Muscles Acting on the Vertebral Column

Figure 10.19

© McGraw Hill 62
 Muscles of the Pelvic Floor 1

Layers of muscles and fasciae that span pelvic outlet

• Penetrated by anal canal, urethra, and vagina
Perineum
• Diamond-shaped region between the thighs
• Bordered by four bony landmarks:
• Pubic symphysis anteriorly
• Coccyx posteriorly
• Ischial tuberosities laterally
• Urogenital triangle
• Anterior half of perineum
• Anal triangle
• Posterior half of perineum

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 Muscles of the Pelvic Floor 2

Layers or compartments of the perineum

• Superficial perineal space
• Ischiocavernosus, bulbospongiosus
• Deep perineal space
• Urogenital triangle—contains deep transverse perineal muscle and
compressor urethrae in females
• Anal triangle
• External anal sphincter
• Pelvic diaphragm—deepest (most superior) layer
• Levator ani—supports viscera and defecation
• Coccygeus muscle(s)

© McGraw Hill 64
 Muscles of the Pelvic Floor 3

Figure 10.21a

© McGraw Hill 65
 Muscles of the Pelvic Floor 4

Figure 10.21b

© McGraw Hill 66
 Muscles of the Pelvic Floor 5

Figure 10.21c

© McGraw Hill 67
 Hernias

A hernia is any condition in which the viscera protrudes

through a weak point in the muscular wall of the
abdominopelvic cavity
Types of hernias:
• Inguinal hernia
• Most common type of hernia (rare in women)
• Viscera enter inguinal canal or even the scrotum
• Hiatal hernia
• Stomach protrudes through diaphragm into thorax
• Overweight people over 40
• Umbilical hernia
• Viscera protrude through the navel

© McGraw Hill 68
 Inguinal Hernia

Figure 10.22

© McGraw Hill 69
 10.4 Muscles Acting on the Shoulder and Upper Limb

Expected Learning Outcomes:

• Name and locate the muscles that act on the pectoral
girdle, shoulder, elbow, wrist, and hand.
• Relate the actions of these muscles to the joint
movements described in chapter 9.
• Describe the skeletal attachments, actions, and
innervation of these muscles.

© McGraw Hill 70
 Muscles Acting on the Shoulder and Upper Limb 1

Compartments

• Spaces where muscles are separated by fibrous

connective tissue sheets (fasciae)

• Each compartment contains one or more functionally

related muscles along with their nerve and blood supplies

• Muscles of upper limbs divided into anterior and posterior

compartments

• Intermuscular septa (thick fascia) separates compartments

© McGraw Hill 71
 Compartment Syndrome

Compartment syndrome may occur when a blood vessel in a

compartment is damaged
• Blood and tissue fluid accumulate
• Fasciae enclose muscle compartments and prevent
expansion
• Mounting pressure obstructs blood flow to compartment
• After 2 to 4 hr of ischemia, nerves begin to die
• After 6 hr, muscles begin to die
• Myoglobin in urine indicates compartment syndrome
• Nerves can regenerate, but muscle damage is permanent
Treatment: immobilization of limb and fasciotomy (incision to
relieve compartment pressure)

© McGraw Hill 72
 Muscles Acting on the Shoulder and Upper Limb 2

Upper limb is used for broad range of actions

• Climbing, grasping, throwing, writing, playing musical
instruments, and manipulating small objects
Functional groupings:
• Muscles that act on the scapula
• Muscles that act on the humerus and shoulder joint
• Muscles that act on the forearm and elbow joint
• Muscles that act on the wrist, hand, and fingers

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 Muscles Acting on the Shoulder 1

A group of muscles attach on the axial skeleton and also on

clavicle or scapula
• Scapula loosely attached to thoracic cage
• Capable of great movement

• Rotation, elevation, depression, protraction, retraction

• Clavicle braces the shoulder and moderates movements

© McGraw Hill 74
 Muscles Acting on the Scapula

Figure 10.23

© McGraw Hill 75
 Muscles Acting on the Shoulder 2

Anterior group of muscles of pectoral girdle

Pectoralis minor
• Ribs 3 to 5 to coracoid process of scapula
• Draws scapula laterally

Serratus anterior
• All ribs to medial border of scapula
• Draws scapula laterally and forward; prime mover for
reaching and pushing

© McGraw Hill 76
 Muscles Acting on the Shoulder 3

Figure 10.16b

© McGraw Hill 77
 Muscles Acting on the Shoulder 4

Muscles of pectoral girdle

• Posterior group (four muscles)
• Trapezius: superficial

• Levator scapulae, Rhomboid minor, and Rhomboid major: deep

© McGraw Hill 78
 Muscles Acting on the Shoulder 5

Figure 10.18

© McGraw Hill 79
 Muscles Acting on the Shoulder 6

Trapezius
• Stabilizes scapula and shoulder
• Elevates and depresses shoulder apex
Levator scapulae
• Elevates scapula
• Flexes neck laterally
Rhomboid minor
• Retracts scapula and braces shoulder
Rhomboid major
• Same as Rhomboid minor

© McGraw Hill 80
 Muscles Acting on the Arm 1

Nine muscles cross the shoulder joint and attach to the

humerus
Two are axial muscles attaching on axial skeleton
• Pectoralis major: flexes, adducts, and medially rotates
humerus
• Latissimus dorsi: adducts and medially rotates humerus

© McGraw Hill 81
 Muscles Acting on the Arm 2

Figure 10.25a Figure 10.25b

© McGraw Hill 82
 Anterior View of Cadaver Chest

Figure 10.26a

© McGraw Hill Rebecca Gray/McGraw-Hill Education 83

 Back Muscles of Cadaver

Figure 10.26b

Access the text alternative for slide images.

© McGraw Hill Rebecca Gray/McGraw-Hill Education 84

 Muscles Acting on the Arm 3

Seven muscles with scapular attachments

• Deltoid
• Rotates and abducts arm
• Intramuscular injection site
• Teres major
• Extension and medial rotation of humerus
• Coracobrachialis
• Flexes and medially rotates arm
• Remaining four form the rotator cuff that reinforce the
shoulder joint

© McGraw Hill 85
 Muscles Acting on the Arm 4

Figure 10.25a Figure 10.25b

© McGraw Hill 86
 Muscles Acting on the Arm 5

Rotator cuff muscles

• Tendons of four scapular muscles form the rotator cuff
• Acronym “SITS muscles”
• Supraspinatus
• Infraspinatus
• Teres minor
• Subscapularis
• Tendons of these muscles merge with the joint capsule of
the shoulder as they cross it in route to the humerus
• Holds head of humerus into glenoid cavity
• Supraspinatus tendon easily damaged

© McGraw Hill 87
 Rotator Cuff Muscles in Relation to the Scapula

Figure 10.24

© McGraw Hill 88
 Muscles Acting on the Elbow and Forearm 1

Muscles that act on the elbow and forearm are located in

both brachium (arm) and antebrachium (forearm)
Four motions:
• Flexion
• Extension
• Pronation
• Supination

© McGraw Hill 89
 Muscles Acting on the Elbow and Forearm 2

Muscles with bellies in the arm (brachium)

• Elbow flexors: anterior compartment
• Principal flexor
• Brachialis

• Synergistic flexors
• Biceps brachii
• Brachioradialis
• Brachialis produces 50% more power than biceps brachii
• Brachialis is prime mover of elbow flexion
• Principal elbow extensor: posterior compartment
• Triceps brachii
• Prime mover of elbow extension
© McGraw Hill 90
 Muscles Acting on the Elbow and Forearm 3

Muscles with bellies in the arm (brachium).

• Elbow flexors: anterior compartment.
• Principal flexor — Brachialis.

• Brachialis is prime mover of elbow flexion.

• Synergistic flexors — Biceps brachii.

• Biceps brachii produces 50% less power than Brachialis.

• Elbow extensor: posterior compartment.

• Principle extensor — Triceps brachii.

• Triceps brachii is prime mover of elbow extension.

© McGraw Hill 91
 Muscles Acting on the Forearm 1

Figure 10.25a Figure 10.25b

© McGraw Hill 92
 Muscles Acting on the Forearm 2

Muscles with bellies in the forearm (antebrachium)

• Brachioradialis: synergistic elbow flexor
• Anconeus: synergistic elbow extensor
• Pronator quadratus: prime mover in forearm pronation
• Pronator teres: assists pronator quadratus in pronation
• Supinator: supinates the forearm

© McGraw Hill 93
 Actions of the Rotator Muscles on the Forearm

Figure 10.27

© McGraw Hill 94
 Muscles Acting on the Wrist and Hand 1

Anterior group
• Intrinsic muscles in the hand itself
• Extrinsic muscles in the forearm
• Extrinsic muscle actions:
• Flexion and extension of wrist and digits

• Radial and ulnar flexion

• Finger abduction and adduction

• Thumb opposition

© McGraw Hill 95
 Muscles Acting on the Wrist and Hand 2

Anterior (flexor) compartment—superficial layer

• Flexor carpi radialis
• Flexor carpi ulnaris
• Flexor digitorum superficialis
• Palmaris longus
Anterior (flexor) compartment—deep layer
• Flexor digitorum profundus
• Flexor pollicis longus

© McGraw Hill 96
 Flexors of the Wrist and Hand

Figure 10.29

© McGraw Hill 97
 Cross Section of Upper Limb

Figure 10.28

© McGraw Hill 98
 Muscles Acting on the Wrist and Hand 3

Posterior group
• Extension of wrist and fingers, adduct/abduct wrist
• Extension and abduction of thumb (pollicis)
• Muscle name can help with identification:
• Brevis means “short”

• Ulnaris indicates “on ulna side of forearm”

© McGraw Hill 99
 Muscles Acting on the Wrist and Hand 4

Posterior (extensor) compartment—superficial layer

• Extensor carpi radialis longus
• Extensor carpi radialis brevis
• Extensor digitorum
• Extensor digiti minimi
• Extensor carpi ulnaris
Posterior (extensor) compartment—deep layer
• Abductor pollicis longus
• Extensor pollicis brevis
• Extensor pollicis longus
• Extensor indicis
© McGraw Hill 100
 Extensors of the Wrist and Hand

Figure 10.30

© McGraw Hill 101

 Carpal Tunnel Syndrome 1

Flexor retinaculum
• Bracelet-like fibrous sheet, passed under by flexor
tendons crossing the wrist
Carpal tunnel
• Tight space between the flexor retinaculum and the carpal
bones
• Flexor tendons passing through the tunnel are enclosed in
tendon sheaths
• Enable tendons to slide back and forth quite easily

© McGraw Hill 102

 Carpal Tunnel Syndrome 2

Prolonged, repetitive motions of wrist and fingers cause

tissues in the carpal tunnel to become inflamed, swollen, or
fibrotic
• Puts pressure on median nerve of wrist that passes
through the carpal tunnel along with flexor tendons
• Tingling and muscular weakness in the palm and medial
side of the hand
• Pain may radiate to arm and shoulder
• Treatment: anti-inflammatory drugs, immobilization of the
wrist, and sometimes surgery to remove part or all of
flexor retinaculum

© McGraw Hill 103

 Carpal Tunnel Syndrome 3

Figure 10.31
© McGraw Hill 104
 Intrinsic Muscles of the Hand 1

Thenar group—fleshy mass at base of thumb

• Adductor pollicis
• Abductor pollicis brevis
• Flexor pollicis brevis
• Opponens pollicis
Hypothenar group—fleshy base of the little finger
• Abductor digiti minimi
• Flexor digiti minimi brevis
• Opponens digiti minimi
Midpalmar group—hollow of palm
• Dorsal interosseous muscles (4)
• Palmar interosseous muscles (3)
• Lumbricals (4 muscles)
© McGraw Hill 105
 Intrinsic Muscles of the Hand 2

Figure 10.32a

© McGraw Hill 106

 10.5 Muscles Acting on the Hip and Lower Limb

Expected Learning Outcomes:

• Name and locate the muscles that act on the hip, knee,
ankle, and toe joints.
• Relate the actions of these muscles to the joint
movements described in chapter 9.
• Describe the skeletal attachments, action, and
innervation of these muscles.

© McGraw Hill 107

 Muscles Acting on the Hip and Lower Limb

Body’s largest muscles found in lower limb

Less for precision, more for strength needed to stand,
maintain balance, walk, and run
Several cross and act on two or more joints
Leg—the part of the limb between the knee and ankle
Foot—includes tarsal region (ankle), metatarsal region, and
the toes

© McGraw Hill 108

 Muscles Acting on the Hip and Femur 1

Anterior muscles of the hip:

• Iliacus
• Flexes thigh at hip

• Iliacus portion arises from iliac crest and fossa

• Psoas major
• Flexes thigh at hip

• Arises from lumbar vertebrae

• Iliacus and Psoas major have common tendon on femur

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 Muscles Acting on the Hip and Femur 2

Figure 10.33
© McGraw Hill 110
 Muscles Acting on the Hip and Femur 3

Lateral and posterior muscles of the hip

• Tensor fasciae latae
• Extends knee, laterally rotates knee
• Gluteus maximus
• Forms mass of the buttock
• Prime hip extensor
• Provides most of lift when you climb stairs
• Gluteus medius and minimus
• Abduct and medially rotate thigh

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 Muscles Acting on the Hip and Femur 4

Figure 10.34

© McGraw Hill 112

 Muscles Acting on the Hip and Femur 5

Posterior group
• Lateral rotators
• Six muscles inferior to gluteus minimus and deep to the two other
gluteal muscles:
• Gemellus superior

• Gemellus inferior

• Obturator externus

• Obturator internus

• Piriformis

• Quadratus femoris

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 Muscles Acting on the Hip and Femur 6

Figure 10.34

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 Muscles Acting on the Hip and Femur 7

Medial (adductor) compartment of thigh

• Five muscles act as primary adductors of the thigh:
• Adductor brevis

• Adductor longus

• Adductor magnus

• Gracilis

• Pectineus

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 Muscles Acting on the Hip and Femur 8

Figure 10.33

© McGraw Hill 116

 Muscles Acting on the Knee and Leg 1

Anterior (extensor) compartment of the thigh

• Contains large quadriceps femoris muscle
• Prime mover of knee extension
• Most powerful muscle in the body
• Has four heads—rectus femoris, vastus lateralis, vastus medialis,
and vastus intermedius
• All converge on single quadriceps (patellar) tendon
• Extends to patella
• Then continues as patellar ligament
• Attaches to the tibial tuberosity

• Sartorius: longest muscle in the body

• “Tailor’s muscle”
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 Superficial Anterior Thigh Muscles of the Cadaver

Figure 10.35

© McGraw Hill Rebecca Gray/McGraw-Hill Education 118

 Anterior Muscles of the Thigh

Figure 10.36

© McGraw Hill 119

 Muscles Acting on the Knee and Leg 2

Posterior (flexor) compartment of the thigh

• Contains hamstring muscles
• From lateral to medial:
• Biceps femoris

• Semitendinosus

• Semimembranosus

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 Muscles Acting on the Knee and Leg 3

Figure 10.34

© McGraw Hill 121

 Muscles Acting on the Foot 1

Crural muscles, acting on the foot, are separated into three

compartments
• Anterior compartment
• Fibular (lateral) compartment
• Posterior compartments (superficial and deep)

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 Muscles Acting on the Foot 2

Figure 10.41b

© McGraw Hill 123

 Muscles Acting on the Foot 3

Anterior (extensor) compartment of the leg

Actions:
• Dorsiflex the ankle
• Prevent toes from scuffing ground when walking
Muscles:
• Fibularis (peroneus) tertius
• Extensor digitorum longus
• Extensor hallucis longus
• Tibialis anterior

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 Muscles of the Leg, Anterior Compartment

Figure 10.38

© McGraw Hill 125

 Muscles Acting on the Foot 4

Posterior compartment
Three muscles of the superficial group:
• Gastrocnemius: plantar flexes foot, flexes knee
• Soleus: plantar flexes foot
• Plantaris: weak synergist of triceps surae
Triceps surae—collective name for gastrocnemius and
soleus
• Attaches to the calcaneus via calcaneal (Achilles) tendon
• Strongest tendon in the body

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 Superficial Muscles of the Leg, Posterior Compartment

Figure 10.39

© McGraw Hill 127

 Muscles Acting on the Foot 5

Posterior compartment
Four muscles of the deep group:
• Flexor digitorum longus: flexes phalanges
• Flexor hallucis longus: flexes great toe
• Tibialis posterior: inverts foot
• Popliteus: acts on knee

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 Deep Muscles of the Leg, Posterior and Lateral
Compartments

Figure 10.40
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 Muscles Acting on the Foot 6

Lateral (fibular) compartment

Two muscles:
• Fibularis longus
• Fibularis brevis
Both plantar flex and evert the foot
• Provide lift and forward thrust

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 Muscles Acting on the Foot 7

Figure 10.40a

© McGraw Hill 131

 Intrinsic Muscles of Foot 1

One dorsal muscle:

• Extensor digitorum brevis extends toes

Four ventral muscle layers:

• Support arches
• Abduct and adduct the toes
• Flex the toes

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 Intrinsic Muscles of Foot 2

Figure 10.42

© McGraw Hill 133

 Common Athletic Injuries

Muscles and tendons are vulnerable to sudden and intense stress

Proper conditioning and warm-up needed
Common injuries include:
• Compartment syndrome
• Shin splints
• Pulled hamstrings
• Tennis elbow
• Pulled groin
• Rotator cuff injury
Treat with rest, ice, compression, and elevation.
“No pain, no gain” is a dangerous misconception
© McGraw Hill 134
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