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Muscle Origin Insertion Innervation Action

Muscle Origin Insertion Innervation Action

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Published by: mcwnotes on Dec 05, 2008
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07/31/2013

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Class of 2009 Co-op Writer: Marisa ChapmanClinical Human AnatomyNovember 28, 2005 (112805)Hour A/B; 1pm-2pmGluteal Region; Dr. Mark Niedfeldt
The Gluteal Region
Note: Dr. Niedfeldt’s lecture followed the outline in the class notes, as well as previous years’ co-opnotes nearly verbatim.
I. Bony Anatomy
(N340-342); use as landmarks
A.Iliac Crest:
The iliac crest is at the level of L4-L5 vertebrae; used as a landmark during epidural
B.
 
Anterior superior iliac spine:
This is where your hands are when they are “on your hips.”
C.
Posterior superior iliac spine:
These are the dimples on either side of the sacrum. Aclinical landmark for the sacroiliac joint.
D.
Ischial tuberosity:
You’re sitting on them; hamstrings attach here.
E.
Greater trochanter (of the femur):
The bony aspect on the side of either hip. Severalmuscles attach here (listed below). The overlying bursa can be injured, resulting introchanteric bursitis. Refer to N469.Note: The sciatic nerve is located between the ischial tuberosity and greater trochanter.
II. Muscles
Refer to body building magazines (or Netter)
A.
Main Functions
in the gluteal region:
leg extension
abduction
lateral rotation (turning foot outwards)
B.
Leg Extension
(N477, 484)
1.Gluteus Maximus
a.
Action: primary hip extensor, lateral rotation of the thigh, raising the trunk from aseated or flexed position. The little old man with a flat butt has an atrophiedgluteus maximus due to decreased activity, and will have problems getting out of his chair and walking up steps. Tell your elderly patients that if they want tomaintain their independence, they need to maintain their gluteus maximus.
 b.
Gluteus maximus is a fast twitch muscle = only flexed in movement. It doesnot fire when standing; during normal walking you don’t use the gluteus maximusvery much.
c.
One of the largest muscles in the body; forms a thick pad over ischial tuberosityfor sitting comfortd.Origin: broadly from the iliac crest, sacrum, coccyx, and sacrotuberous ligament
e.
Insertion: 2/3 of gluteus maximus inserts on the iliotibial tract (fascia) and the reston the gluteal tuberosity of the femur. For more intense activities such asrunning, the iliotibial band will tighten up and recruit the gluteus maximus.
f.
Innervation: inferior gluteal nerve (S1), below piriformis.
g.
Test by having person lie prone (face down), bend the knee to relax the hamstringand isolate the gluteus maximus, and raise the thigh off the table.h.Arterial Blood Supply: Inferior Gluteal Artery
1
 
2.
Hamstring
muscles (3 of them coming down the posterior aspect of the thigh)
a.
Biceps femoris
laterally- most lateral muscle1)two heads- long and short2)Origin: long head- ischial tuberosity; short head- linea aspera and lateralsupracondylar line of femur (note: I took this from the textbook for the sake of completeness, but he did not specifically state this in lecture)
3)
Insertion: lateral side of head of fibula (again, from textbook)4) Innervation: long head- tibial division of sciatic nerve (S1); short head- fibular (peroneal) division of the sciatic nerve (S1)
 b.
Semitendinosis
and
semimembranosis
medially
1)
Common origin: ischial tuberosity
2)
Insertion: semitendinosis- medial tibia; semimembranosis- medial tibialcondyle
3)
Innervation: tibial division of the sciatic nerve (L5)c.Action of hamstring muscles: extensors of thigh and flexors of the leg
d.
Test hamstrings by having the patient lie supine (face up) and provide resistanceas they attempt to flex their leg
C.
Abduction
(N484)
1.Gluteus medius
a.Thick, triangular muscleb.When looking at someone from behind, this is the hollow dimple of the butt, asopposed to the round area
c.
Action: primary abductor; also flexor, medial rotator (anterior portion) & lateralrotator and extensor (posterior portion), also responsible for tilting of the hip/pelvisd.Origin: ilium tuberositye.Insertion: lateral surface of greater trochantef.Innervation: superior gluteal nerve (L5)g.Stabilizes hip when walking and standing
h.
Weakness can result in Trendelenburg gait (aka “sexy walk”), in which the hipdrops and swings out when weight is transferred to the leg (individual cannotstabilize hip and must move their center of gravity to keep from falling). Couldresult from an injury to the superior gluteal nerve, but also seen in long-distancerunners (weakness in gluteus medius from continual
forward 
motion can stretchthe IT band, causing the trochanter bursa to flare up, thus creating hip & kneepain, and resulting in a subtle, shifting movement, i.e., a less obviousTrendelenburg gait). In the case of runners, treatment involves sideways walkingwith resistance to strengthen the hips. Why don’t basketball players get this?Because of strong gluteus medius muscles from continual
sideways
motion.i.Test by having patient lie on side and provide resistance as they try to abduct theleg 
2.Gluteus minimus
a. Triangular muscle, deep to the gluteus mediusb. Action: secondary abductor & medial rotator of the thigh (more of a rotator than thegluteus medius)c. Origin: iliumd. Insertion: anterior surface of greater trochanter e. Innervation: superior gluteal nerve (L5)
2
 
D.
Lateral rotation
 
1.
Piriformis
a.
Action: lateral rotator; also abducts a flexed thigh (turning leg out while sitting)
 b.
Important landmark: In 85-86% of population, the sciatic nerve passes betweenthe piriformis and superior gemellus. In 10-12 % of people, the tibial part of thesciatic nerve pierces the piriformis. In 0.5 % of people, the tibial part can actuallypass over the piriformis, in which case the sciatic splits the piriformis.Note: A tight piriformis can put pressure on the sciatic nerve causing sciatica;patients with the alternate sciatic nerve pathways are more prone to sciatica.
c.
More landmarking: Nerves and vessels named according to relationship topiriformis; those superior to (above) the piriformis are “superior” (e.g., superior gluteal artery and nerve). Those below are “inferior” (e.g. inferior gluteal arteryand nerve).
d.
Even more landmarking: Superior to the piriformis (estimated by tracing a linebetween sacrum and the greater trochanter) is considered a “safe” area to give agluteal injection (you won’t hit the sciatic nerve)e.Origin: anterior surface of sacrum & sacrotuberous ligament, through the greater sciatic foramenf.Insertion: superior border of greater trochanteg.Innervation: ventral rami of S1, S2, (and S3)
2.Obturator internus
a.Action: laterally rotates an extended thigh; abducts a flexed thighb.Origin: pelvic surface of obturator membrane and surrounding bonesc.Exits pelvis via lesser sciatic foramend.Insertion: medial surface of greater trochante
e.
Innervation: nerve to obturator (L5, S1-S2)
3.Superior and inferior gemelli
a.Action: laterally rotates extended thigh and abducts a flexed thighb.Origin (superior): ischial spinec.Origin (inferior): ischial tuberosityd.Insertion (both): obturator internus tendone.Innervation (superior): nerve to obturator internusf.Innervation (inferior): nerve to quadratus femoris
g.
They surround and reinforce the obturator internus
4.Quadratus Femoris
a.Rectangular muscleb.Action: Lateral rotationc.Origin: lateral border of ischial tuberosityd.Insertion: intertrochanteric crest of femur e.Innervation: nerve to quadratus femoris
3

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