Muscles of the back

Muscles of the back are arranged in two layers:

1)The superficialis muscles;
2)The deep muscles.

A. Superficial muscles of the back

Superficialis muscles of the back are divided into two groups:
1) Muscles attached to the shoulder girdle and upper arm;
2) Muscles attached to the ribs.

Muscles attached to the shoulder girdle and upper arm

1)The trapezius muscle -m.trapezius is wide and triangular. It arises from the su-
perior nuchal line, the all cervical and thoracic vertebrae, and is attached to the
acromion end of the clavicle and the spine of the scapula.
Action. The trapezius muscle suspends the shoulder girdle from the skull and ver-
tebral column. Upper fibers of the muscle elevate shoulder girdle, the lower fibers
pull the scapula downward. All the fibers of the muscle pulls the shoulders to the
back.
2) The latissimus dorsi muscle -m. latissimus dorsi occupies the whole lower part
of the back. It arises from the spinous processes of the lower five thoracic, all the
lumbar vertebrae and the sacrum, iliac crest and from the lower four ribs and is
attached to the lesser tubercle crest of the humerus.
Action. It extends, adducts, and medially rotates the arm.
3) The romboid muscle -m.romboideus is quadriangular and is located under the
trape-zius muscle. It arises from the II -VII cervical vertebrae and spinous process of
the upper four thoracic ver-tebrae and is attached to the medial border of the scapula.
Action. It elevates the medial border of the scapula and pulls it medially.
4) The levator scapulae muscle -m. levator scapulae. It arises from the pos-terior
tubercles of the transverse processes of the upper four cervical verte-brae and is
attached to the superior angle and medial margin of the scapula.
Action. It raises the medial border of scapula.

Muscles attached to the ribs

1) The serratus posterior superior muscle -m.serratus posterior superior is lo-cated
under the romboid muscle. It arises from the spinous processes of the lower two
cervical and upper two thoracic vertebrae and is attached to the angles of the II -V
ribs.
Action. Raises the ribs.
2) The serratus posterior inferior muscle -m. serratus posterior inferior, arises from
the thoracolumbar fas-cia, and upper two lumbar vertebrae and is attached to the
external surface of the ninth, eleventh and twelth ribs.
Action. Pulls the lower ribs downwards.

The deep muscles of the back

1) The splenius capitis and splenius cervicis muscles - m.splenius capitis et
splenius cervicis are located under the trapezius, romboid and the serratus posterior
superior muscles. These muscles arise from the nuchal
ligament, spinous processes of the VII cervical and six upper thoracic vertebrae. The
splenius cervicis muscle is attached to the posterior tuber-cles of the transverses
processes of the upper three cervical vertebrae.
The splenius capitis muscle is attached to the mastoid process of the temporal bone
and the superior nuchal line.
Action. In contraction of one muscle the head turns in its direction. Contraction both
muscle bends the head and neck backwards.
Action. Erects the spine.
2) The erector spinae muscle -m.erector spinae. It arises from the sacrum, spinous
processes of the lumbar vertebrae, iliac crest, and the thoracolumbar fascia and forms
three divisions according to the insertion:
a) into the ribs, the iliocostalis muscle -m. iliocostalis;
b) into the transverse processes, the longissimus muscle -m.longissimus;
c) into the spinous ptocesses, the spinalis muscle - m.spinalis.

3) The transversospinalis muscle -m. transversespinalis arises from the transverse

processes of the vertebrae and is attached to the spinus processes of vertebrae. It is
divided into the following three parts:
a) the semispinalis muscle -m. semispinalis;
b) the multifidus muscle - m. multifidus ;
c) the rotatores muscles -mm. rotatores.

The semispinalis muscle topographically consists of three parts:

1)semispinalis thoracic muscle;
2)semispinalis cervicis muscle;
3)semispinalis capitis muscle.

Action. Semispinales thoracic and cervicis muscles extend the thoracic and cervi-cal
vertebral regions, rotating them contralaterally; semispinalis capitis muscle extends
the head.
The multifidius muscles rotate the vertebral column and extend it.
The rotators muscles rotate the vertebral column.
4) The intertransverse muscles -mm. Intertransversarii lie between the transverse
procsses of the cervical and lumbar vertebrae.
Action. Flexes the vertebral column laterally.
5) The interspinales muscles - mm. interspinales lie between the spinous proc-esses
of the cervical and lumbar vertebrae.
Action. Flex the vertebral column backwards.
6) The levatores costarum muscles - mm. levator costarum arise from the trans-
verse processes of the VII cervical and I -IX thoracic vertebrae and are attached to
the angle of the ribs.
Action. Elevate the ribs.

Topography of the back

1) The lumbar triangle - trigonum lumbale (Petit's triangle) is bounded anteri-orly
by the posterior border of the external oblique muscle of the abdomen, poste-riorly
by the anterior border of the latissimus dorsi muscle and inferiorly by the iliac crest.
2) The lumbar quadriangle or spatium tendinus lumbale is bounded superiorly by
the inferior border of the XII rib and posterior inferior serratus muscle, inferi-orly by
the internal oblique muscle of the abdomen, anteriorly by the external oblique muscle
of the abdomen, and posteriorly by the lateral border of the erector spine muscle.

The muscles of the upper limb

The muscles of the upper limb are divided into four groups:
1) Muscles of the shoulder girdle;
2) Muscles of the upper arm;
3) Muscles of the forearm;
4) Muscles of the hand.

Muscles of the shoulder girdle

Topographically the muscles of the shoulder girdle are divided into two groups:
1) the superficial muscles;
2) the deep muscles.
A. The superficial muscles of the shoulder girdle
1) The deltoid muscle - m. deltoideus arises from the acromion end of the clavicle
and, also the acromion process and the spine of the scapula. It is attached to the
deltoid tuberosity of the humerus.
Action. The deltoid muscle abducts the upper limb at the shoulder joint. Elevation of
the arm above the head is accomplished by rotating the scapula.

B. The deep muscles of the shoulder girdle

1) The supraspinatus muscle - m. supraspinatus arises from the supraspinous fossa
and is attached to the greater tubercle of the humerus.
Action. Adduct the arm.
2) The infraspinatus muscle - m. infraspinatus arises from the in-fraspinous fossa
and is attached to the greater tubercle of the humerus.
Action. Rotates the humerus laterally.

3) The teres minor muscle - m. teres minor arises from the lateral margin of the
scapula and is attached to the greater tubercle of the hume-rus.
Action. Rotates the humerus laterally.
4) The teres major muscle - m. teres major arises from the inferior angle of the
scapula and is attached to the crest of lesser tubercle of the humerus.
Action. Pulls the arm to the back and downward.
5) The subscapularis muscle -m. subscapularis arises from the costal surface of the
scapula and is attached to the lesser tubercle of the humerus.
Action. Rotates the arm medially.

Muscles of the arm

Muscles of the upper arm are divided into two groups:
1)The anterior muscles (flexors);
2)The posterior muscles (extensors).
A. The anterior mus-cles of the arm
1) The biceps brachii muscle -m. biceps brachii is a large muscle. It has two heads:
a) a long head; b) a short head.
The long head arises from the supraglenoid tubercle of the scapula and the short
head arises from the corocoid process of the scapula. Both heads units and are
attached to the radial tuberosity.
Action. Flexes the forearm at the elbow joint.
2) The coracobrachialis muscle -m. coracobrachialis arises from the corocoid
process of the scapula and is attached to the medial surface of the hu-merus (fig.136).
Action. Elevates forward and adducts the arm.
3) The brachialis muscle - m. brachialis arises from the ante-rior surface of the
humerus and is attached to the ulnar tuberosity.
Action. Flexes the forearm at the elbow joint.
B. The posterior mus-cles of the arm
1)The triceps brachii muscle - m. triceps bracii, occupies the posterior surface of
the arm. It has three heads:
1) the long head -caput longum;
2) the lateral head - caput laterale;
3) the medial head -caput medialis.

The long head, arises from the infraglenoid tubercle of the scapula; the lateral head,
arises from the upper half of the posterior surface of the shaft of the humerus above
the spiral groove (sulcus nervi radialis); the medial head, arises from the posterior
surface of the lower half of the shaft of the humerus below the spiral groove.
Three heads unite to form a common tendon and is attached to the olecranon process
of the ulna.
Action. Extends the forearm at the elbow joint.
2) The anconeus muscle - m. anconeus, is a small and triangular muscle. It arises
from the lateral epicondyle of the humerus and is attached to the posterior surface of
the ulna.
Action. Extends the forearm at the elbow joint.
Muscles of the forearm
The muscles of the forearm are divided into two groups:
1) The anterior group, is composed of flexors and pronators;
2) The posterior group, is composed of extensors and supinators.

Each group consists of a superficial and a deep layers.

The muscles of the anterior group of the forearm arise from the medial epicondyle,
and the posterior group from the lateral epicondyle of the humerus.

Muscles of the anterior group of the forearm

The anterior muscles of the forearm are divided into two groups:
a) superficial muscles;
b) deep muscles.

A. Superficial muscles
1) The pronator teres muscle -m. pronator teres has two heads:
a) The humeral head -caput humerale, arises from the medial epicondyle of the
humerus and the medial intermuscular septum;
b) The ulnar head -caput ulnare, arises from the coronoid process of the ulna.

Both head unite to form a tendon and is attached to the radial tuberosity.
Action. Flexes and pronates of the forearm.
2) The flexor carpi radialis muscle -m. flexor carpi radialis, arises from the me-dial
epicondyle of the humerus and is attached to the base of the second and third
metacarpal bone.
Action. Flexes and abducts the hand at the wrist joint.
3) The palmaris longus muscle - m. palmaris longus (it is often absent), arises from
the medial epicondyle and is inserted into the flexor retinaculum and palmar
aponeurosis.
Action. Flexes the hand at the wrist joint.
4) The flexor carpi ulnaris muscle - m. flexor carpi ulnaris has two heads:
a) the humeral head - caput humerale, arises from the medial epicondyle of the
humerus;
b) the ulnar head - caput ulnare, arises from the olecranon process of the ulna and
the posterior border of the ulna.

Both heads unite to form a long tendon and is attached to the pisiform bone.

Action. Flexes and adducts the hand at the wrist joint.

5) The flexor digitorum superficialis muscle -m. flexor digitorum superficialis, has
two heads:
a) the humeroulnar head -caput humeroulnaris, arises from the medial epicondyle
of the hu-merus and the medial margin of the coronoid process of the ulna;
b) the radial head -caput radialis, arises from the anterior surface of the radius.

The two heads unite to form the belly and in the lower part of the forearm this gives
rise to four tendons. These tendons of the muscle are attached to the medial phalanx
of the in-dex, middle, ring and little finger.
Action. Flexes the middle phalanx of the fingers.
B. Deep muscles
1) The flexor digitorum pro-fundus muscle - m. flexor digitorum profundus, arises
from the anterior and medial surfaces of the shaft of the ulna and the interosseus
membrane. Above the wrist, the muscle divides into four ten-dons. These tendons
are at-tached to the base of the distal phalanx of the index, middle, ring and little
fingers.
Action. Flexes the distal phalanx of the fingers; it also assists in flexing the wrist.
2) The flexor pollicis longus muscle - m. flexor pollicis longus, arises from the
anterior surface and medial epicondyle of the humerus and from the interosseus
membrane and is attached to the base of the distal phalanx of the thumb.

Action. Flexes the distal phalanx of the thumb.

3) The pronator quadratus muscle - m. pronator quadratus, arises from the lower
quarters of the anterior surface of the shaft of the ulna and is attached to the lower
quarter of the anterior surface of the radius.
Action. Pronates the forearm.
Muscles of the posterior group of the forearm
Muscles of the posterior group of the forearm are divided into two groups:
a) lateral muscles;
b) medial muscles.

A.The lateral muscles

1) The brachioradialis muscle - m.brachioradialis, arises from the lateral epi-
condyle of the humerus and lateral intramuscular septum and is attached to the base
of the styloid process of the radius.
Action. Flexes the forearm at the elbow joint, it also assists in rotating the forearm.

2) The extensor carpi radialis longus muscle -m. extensor carpi radialis longus,
arises from the lateral border of the humerus and lateral intramus-cular septum and
is attached to the base of the second metacarpal bone.
Action. It extends and abducts the hand at the wrist joint.
3) The extensor carpi radialis brevis muscle - m.extensor carpi radialis brevis,
arises from the lateral epi-condyle of the humerus and is at-tached to the posterior
surface of the base of the third metacarpal bone.
Action. It extends and abducts the hand at the wrist joint.
B.Medial muscles
1) The extensor digitorum muscle -m. extensor digitorum, arises from the lateral
epicondyle of the humerus.
The muscle divides into four tendons and is attached to the base of the middle
phalanx of the index, middle, ring and little fingers.
Action. It extends the metacarpophalangeal joint; it also assists in extending the
hand.

2) The extensor digiti minimi muscle -m. extensor digiti minimi, arises from the
lateral epicondyle of the humerus and is attached to the middle and distal phalanx of
the little finger.
Action. Extends the little finger.
3) The extensor carpi ulnaris muscle - m. extensor carpi ulnaris, arises from the
lateral epicondyle of the humerus and is attached to the posterior surface of the base
of the fifth metacarpal bone.
Action. Extends and adducts the hand at the wrist joint.
4) The supinator muscle - m. supinator, arises from the lateral epicondyle of the
humerus and supinator crest of the ulna and is attached to the anterior and lateral
surfaces of the radius.
Action. It assists in supination of the forearm.
5) The abductor pollisis longus muscle -m. abductor pollisis longus arises from the
posterior surface of the shaft of the ulna and radius, and the interosseus mem-brane.
It is attached to the base of the first metacarpal bone.
Action. Abducts and extends the thumb.
6) The extensor pollisis brevis muscle -m. extensor pollisis brevis, arises from the
posterior surface of the radius and interosseus membrane and is attached to the base
of the proximal phalanx of the thumb.
Action. Extends the thumb.

7) The extensor pollisis longus muscle -m. extensor pollisis longus, arises from the
poste-rior surface of the ulna and in-terosseus membrane and is at-tached to the distal
phalanx of the thumb.
Action. Extends the thumb.
8) The extensor indicis muscle -m. extensor indicis,arises from the posterior surface
of the ulna and interosseus membrane and is inserted into the extensor expansion of
the index finger.
Action. Extends the index fin-ger.
Muscles of the hand
The muscles of the hand are divided into three groups:
A. Muscles of the thumb;
B. Muscles of little finger;
C. Muscles of the palm.

Muscles of the thumb (thenar)

The muscles of the thumb are located on the radial side of the palm and form the
thenar eminence - thenar.
1) The abductor pollicis brevis muscle -m. abductor polliscis brevis, arises from the
scaphoid bone and the flexor retinaculum and is attached to the base of the proximal
phalanx of the thumb.
Action. Abducts the thumb.
2) The flexor pollicis brevis muscle -m. flexor pollicis brevis arises from the tra-
pezium and the flexor retinaculum and is attached to the base of the proximal pha-
lanx of the thumb.
Action. Flexes the thumb.
3) The opponens pollicis muscle - m. opponens pollicis, arises from the flexor
retinaculum and trapezium bone and is attached to the lateral border of the shaft of
the first metacarpal bone.
Action. Opposes the thumb.
4) The adductor pollicis muscle -m. adductor pollicis has two heads:
a) the oblique head, arises from the anterior surface of the base of the second and
third metacarpal bones;
b) the transverse head, arises from the anterior surface of the third metacarpal bone.

Two heads are attached to the base of the proximal phalanx of the thumb.

Action. Adducts the thumb.

Muscles of the little finger (hypothenar)
The muscles of the little finger are located on the ulnar side of the palm and form the
hypothenar emi-nence -hypothenar.
1) The short palmar muscle -m. palmaris brevis arises from the ulnar bor-der of the
palmar aponeurosis and the flexor reti-naculum and ends in the skin of the palm.
Action. Tenses the palmar aponeurosis.
2) The abductor digiti minimi muscle -m. abductor digiti minimi arises from the
pisiform bone and is attached to the base of the proximal phalanx of the little fin-ger.
Action. Abducts the little finger.
3) The flexot digiti minimi muscle - m. flexor digiti minimi arises from the hook of
the hamate bone and the flexor retinaculum and is inserted into the base of the
proximal phalanx of the little finger.
Action. Flexes the little finger.
4) The opponens digiti minimi muscle - m. oppo-nens digiti minimi arises from the
anterior surface of the flexor retinaculum and from the hook of the hamate bone and
is at-tached to the medial border of the fifth metacarpal bone.
Action. Opposes the little finger.
Muscles of the palm
1) The lumbrical muscles -mm. lumbricales are four in number and arise from the
tendons of the flexor digitorum profundus in the palm.
Each muscle is inserted into the lateral side of the corresponding extensor expan-
sion.
Action. They flex the metacarpophalangeal joints and extend the interphalangeal
joints.
2) The palmar interossei muscles -mm. palmaris interosseus are four in number.
The first palmar interosseus muscle arises from the medial side of the first meta-
carpal bone and is attached to the medial side of the base of the proximal phalanx of
the thumb.
The second, third and fourth arise from the anterior surface of the second, fourth
and fifth metacarpal bones.
The second palmar interosseus muscle is attached to the medial side of the base of
the proximal phalanx of the index finger.
The third and fourth are attached to the lateral side of the corresponding bones of
the fingers.
Action. They adduct the fingers, flex the metacarpophalangeal joints, and extend the
interphalangeal joints.
3) The dorsal interossei muscles -mm. interossei dorsales, arise from the contigu-
ous sides of the metacarpal bones and is attached to the proximal phalanx corre-
sponding fingers.
Action. They abduct the fingers.
TOPOGRAPHY OF THE SCAPULAR REGION
• Landmarks: acromion, superior angle of the scapula, inferior angle of
the scapula. Borders: Superior – horizontal line drawn through the
acromion . Inferior – horizontal line drawn through the inferior angle of
the scapula. Lateral – vertical line drawn through the acromion. Medial –
medial margin of the scapula. Layers: Skin: it is thick with limited
movement.
Subcutaneous tissue. Superficial fascia: it is dense and consists of many
layers. It contains the fibrous tissues which connect the subcutaneous tissue
and are fixed to the skin. That is why the skin has limited movement. It
contains fat and cutaneous nerve. Deep fascia: it consists of 2 layers:
superficial layer covers the latissimus dorsi and trapezius muscles. Deep layer
covers the supraspinatus, infraspinatus, teres major and teres minor muscles
TOPOGRAPHY OF THE AXILLARY REGION
Landmarks: Outlines of the pectoralis major, latissimus dorsi and
coracobrachialis muscles; axillary fossa is shown by lifting up the upper
extremity. Borders: anterior- lower margin of the pectoralis major muscle;
posterior – lower margin of the latissimus dorsi muscle; medial – line
connecting the margin of the pectoralis major and latissimus dorsi muscles
along the saggital section of the lateral surface of the thorax at the level of
the 3rd rib; lateral – line connecting the margin of the pectoralis major and
latissimus dorsi muscles on the medial surface of the arm.
• Layers: Skin: it is thin and easily movable. It contains the suspensory
ligament of the axilla. It separates and forms the pectoral fascia anteriorly,
thoracolumbar fascia posteriorly and brachial fascia laterally.
• Axillary cavity: Borders: Anterior – pectoralis major muscle and
clavipectoral fascia. Posterior – subscapularis, latissimus dorsi, teres major
muscles. Medial – thoracic wall, serratus anterior muscle and 1st until 4th
intercostal muscles. Lateral – surgical neck of the humerus, short head of the
biceps brachii muscle and coracobrachialis muscle.
 Contents: axillary is divided into 3 parts and gives branches according to:
clavipectoral triangle (thoracoacromial artery, arteria thoracica suprema,
lateral and medial pectoral nerves); pectoral triangle ( lateral thoracic artery
and long thoracic nerve); subpectoral triangle(subscapular artery, anterior
and posterior circumflex humeral arteries).
TOPOGRAPHY OF THE ANTERIOR REGION OF THE ARM
Landmarks: deltoid muscle, pectoralis major muscle, latissimus dorsi muscle, biceps
brachii muscle, triceps brachii muscle, medial and lateral epicondyles of the
humerus, greater tubercule of the humerus; sulci bicipitales lateralis et mediales.
Borders: Superior – horizontal line drawn from the pectoralis major and latissimus
dorsi muscles. Inferior – imaginary line drawn with 2 fingers above the lateral and
medial epicondyles of the humerus; medial and lateral: vertical lines drawn on medial
and lateral epicondyles of the humerus respectively. Layers: Skin: lateral is thicker
than the medial one. It is slightly movable.
• Subcutaneous tissue: it contains the cephalic and basilic veins. It contains the
cubital lymph nodes.
• Superficial fascia: it forms a covering for the superficial veins and cutaneous
nerves. Deep fascia: it forms 2 septa which are connected to the humerus,
namely the lateral and medial intermuscular septa. These 2 septa divide the
brachial region into anterior and posterior parts. Transverse septum is pierced
by the ulnar nerve and anterior descending branch of profunda brachii artery
to the anterior surface of the lateral epicondyle. Anteroposterior septum
separates the brachalis muscle from the muscles attached to the lateral
supracondylar ridge. This septum also encloses the radial nerve and anterior
descending branch of the deep artery of arm.
TOPOGRAPHY OF THE POSTERIOR REGION OF THE ARM
Landmarks: deltoid muscle, pectoralis major muscle, latissimus dorsi muscle, biceps
brachii muscle, triceps brachii muscle, medial and lateral epicondyles of the
humerus, greater tubercle of humerus, sulcus deltoideopectoralis, sulci bicipitales
lateralis et mediales. Borders: Superior – horizontal line drawn from the pectoralis
major latissimus dorsi muscles. Inferior – imaginary line drawn with 2 fingers above
the lateral and medial epicondyles of the humerus. Medial and lateral – vertical lines
drawn on the medial and lateral epicondyles of the humerus respectively.
Layers: Skin: it is thick and well-connected with the subcutaneous tissue.
Subcutaneous tissue: it contains the superior lateral cutaneous nerve of the arm,
inferior lateral cutaneous nerve of the arm and posterior cutaneous nerve of the
forearm.
Superficial fascia.
Deep fascia:
It forms a covering for the triceps brachii muscle and its tendon.
Humeromuscular canal: it is also known as canalis spiralis. Radial nerve, deep artery
of arm and its vein pass through this canal. Superior trilateral foramen
Borders: Medial – teres minor muscle. Lateral – medial margin of the long head
of the triceps muscle. Inferior – teres major muscle. Contents: circumflex scapular
artery. Inferior trilateral foramen
Borders: Medial – long head of the triceps brachii muscle;lateral – medial margin
of the humerus. Superior – teres major muscle. Contents: radial nerve, deep artery of
the arm.
• Quadrilateral foramen Borders: Medial – lateral margin of the lons head of
the triceps brachii muscle; Lateral – surgical neck of the humerus. Superior
– teres minor muscle, subscapularis muscle. Inferior – teres major muscle.
There are three grooves between the forearm muscles:
1. The medial, ulnar groove lies between the m.flexor carpi ulnaris (medially)
and m.flexor digitorum superficialis (laterally). It transmits the ulnar nerve,
artery, and veins.
2. The lateral, radial groove lies between the m.brachioradialis (laterally) and
m.flexor carpi radialis (medially). It transmits the radial nerve, artery, and
veins.
3. The median groove lies between the flexor carpi radialis (laterally) and the
flexor digitorum superficialis (medially). It transmits the median nerve.
In the region of the wrist joint, three canals form as a result of the flexor
retinaculum nearby. Bridging the space between the eminentia carpi ulnaris and
eminentia carpi radialis, the flexor retinaculum converts the groove between
these eminences, the carpal sulcus (sulcus carpi), into the carpal canal or tunnel
(canalis carpalis). Then separating and running to the radial and ulnar sides, the
flexor retinaculum forms, respectively, the canalis carpi radialis and canalis carpi
ulnaris.
The ulnar nerves and vessels that extend from the sulcus ulnaris of the forearm
pass in the ulnar canal (tunnel). The tendon of the flexor carpi radialis ensheathed
in a synovial sheath lies in the in the canalis carpi radialis. Finally, in the canalis
carpalis are two separate synovial sheaths, one for the tendons of mm.flexores
digitorum superficialis and profundus, the other for the tendon of m.flexor
pollicis longus.
The first, the common synovial sheath of the flexor tendons is a large medially
located sac enclosing eight tendons of the deep and superficial flexors of the
fingers. Superiorly, it protrudes 1-2 cm proximally of the flexor retinaculum,
while inferiorly it reaches the middle of the palm. The sheath continues only on
the tendons of the long flexors of the little finger, surrounds them, and reaches,
together with them, the base of the distal phalanx of the little finger.
The second, the synovial sheath of the long flexor muscle of the thumb is situated
laterally. This long, narrow canal encloses the tendon of the long flexor muscles
of the thumb. Superiorly, this sheath also protrudes 1-2 cm proximally of the
flexor retinaculum, while inferiorly it extends on the tendon to the base of the
distal phalanx of the thumb. The remaining three fingers have separate sheaths,
synovial sheaths of the tendons of the hand, digital, enclosing the tendons of the
flexors of the corresponding finger.
These sheaths stretch from the line of the metacarpophalangeal joints to the base
of the distal phalanges. Consequently, the index, middle, and fourth fingers have
isolated sheaths for the tendons of their common flexors on the palmar surface
but are devoid of these sheaths in the segment corresponding to the distal halves
of the metacarpal bones.
The synovial sheaths on the palmar surface of the fingers are covered by a dense,
fibrous lamina that fuses with the ridges on the edges of the phalanges and forms
an osteofibrous canal on each finger, which surrounds the tendons and their
sheath. The fibrous walls of the canal are very thick near the phalangeal shafts,
where they form transverse thickening (pars anularis vaginae fibrosae). They are
much thinner near the joints and are strengthened by bundles of connective tissue
(pars cruciformis vaginae fibrosae) which intersect obliquely. The tendons are
connected with the walls of the enclosing sheaths by a thin mesotendineum
transmitting blood vessels and nerves.

• The antebrachial fascia invests the forearm muscles muscles and produces
fibrous septa which project between them. It also fuses with the epicondyles
of the humerus and the posterior border of the ulna.
• On its dorsal border with the hand, the antebrachial fascia forms a transverse
thickening in the form of a ligament, which is called the extensor
retinaculum. Processes from the retinaculum fuse with the dorsal surface of
the radius and ulna. Between these processes, under the ligament, are six
canals, which are partly osteofibrous and partly fibrous. These canals
transmit the tendons of the finger and wrist extensors.
• If we count from the radial to the ulnar border the first canal transmits the
tendons of the abductor pollicis longus and the extensor pollicis brevis. The
second canal (sometimes a double canal) transmits the tendons of the
extensor carpi radials longus and brevis. The third, crossing the preceding
 canal obliquely, transmits the tendon of the extensor pollicis longus. The
fourth canal transmits the tendons of the extensor digitorum and the extensor
indicis, while the fifth canal, situated more superficially, transmits the
tendon of the extensor digiti minimi. Finally, the sixth canal transmits the
tendon of the extensor carpi ulnaris.
•
• The muscles of the lower limb
• The muscles of the lower limb are divide into four groups:
• 1) Muscles of the hip region;
• 2) Muscles of the thigh;
• 3) Muscles of the leg;
• 4) Muscles of the foot.
•
• Muscles of the hip region
• The muscles of the hip region are divided into two groups:
• 1) the internal muscles;
• 2) the external muscles.
•
• A.The internal muscles of the hip region
• 1) The iliopsoas muscle -m. iliopsoas, consists of two heads:
• a) the psoas major muscle - m. psoas major;
• b) the iliacus muscle -m. iliacus.
• The psoas major muscle arises from the transverse processes, the lateral
surface of the vertebral bodies and the intervertebral discs, from the twelfth
thoracic to the fifth lumbar vertebrae.
• The iliacus muscle arises from the upper part of the iliac fossa.
• Both heads unite to be inserted into the lesser trochanter of the femur.
• Action. Flexes the thigh at the hip joint; if the thigh is fixed, it flexes the trunk
on the thigh.
• 2) The psoas minor muscle -m. psosa minor, arises from the twelfth thoracic
and first lumbar vertebrae and is at-tached to the iliopubic emi-nence.
• Action. It tenses the iliac fascia.
• 3) The piriformis muscle -m. piriformis, arises from the anterior surface of
the sacrum and is attached to the greater trochanter of the fe-mur.
• Action. Rotates the thigh laterally.
• 4) The obturator in-ternus muscle - m. obturatorius internus, arises from
the pelvic surface of the obtura-tor membrane and the surrounding bones and
is attached to the tro-chanter fossa of the femur.
• Action. Rotates the thigh laterally.
• B. The external muscles of the hip region
• 1) The gluteus maximus muscle - m. gluteus maximus is the largest muscle
in the body. It arises from the external surface of the ilium, from the posterior
surface of the sacrum and coccyx, from the thoracolumbar fascia.The fibers
pass downward and laterally, and are inserted into the iliotibial tract; some of
the fibers are in-serted into the gluteal tuberosity of the femur.
• Action. It extends and laterally rotates the hip joint.
• 2) The gluteus medius muscle -m. gluteus medius, is a thick fan-shaped
muscle. It arises from the external surface of the ilium and from the fasciae
latae and is at-tached to the greater trochanter of the femur.
• Action. Abducts the thigh; the anterior fibers also medially rotate the thigh.
• 3) The gluteus minimus muscle - m. gluteus minimus, lies deep to the
gluteus medius. It arises from the external surface of the ilium and is attached
to the greater trochanter of the femur.
• Action. Abducts the thigh; the anterior fibers also medially rotate the thigh.
• 4) The tensor fasciae latae muscle -m. tensor fasciae latae, arises from the
ante-rior superior iliac spine and is attached to the iliotibial tract.
• Action. It tenses the iliotibial tract; fixes the hip joint and also medially
rotates the thigh.
• 5) The quadratus femoris muscle - m. quadratus femoris, is a quadriangular
mus-cle. It arises from the ischial tuberosity and is attached to the greater
trochanter and intertrochanteric crest.
• Action. Rotates the thigh laterally.
• 6) The gemellus superior muscle - m. gemellus superior, is a small muscle.
It arises from the spine of the ischium and is attached to the trochanteric fossa
of the femur.
• Action. Rotates the thigh laterally.
• 7) The gemellus inferior muscle - m. gemellus inferior, is a small muscle. It
arises from the ischial tuberosity and is attached to the trochanteric fossa of
the femur.
• Action. Rotates the thigh laterally.
• 8) The obturatorius externus muscle - m. obturatorius exter-nus, arises
from the obturator membrane and from pelvic bones along the margin of the
obturator foramen and is attached to the trochanteric fossa of the femur.
• Action. Rotates the thigh laterally.
• Muscles of the thigh
• The muscles of the thigh are di-vided into three groups:
• 1) the anterior muscles;
• 2) the posterior muscles;
• 3) the medial muscles.
• The anterior muscles of the thigh
• 1) The saritorius muscle -m. saritorius, is a narrow strap -shaped muscle. It
arises from the anterior superior iliac spine and is attached to the tibial
tuberosity.
• Action. Flexes, abducts and laterally rotates the thigh at the hip joint.
• 2) The quadriceps femoris muscle -m. quadriceps femoris, consists of four
heads:
• a) the rectus femoris muscle - m. rectus femoris;
 • b) the vastus lateralis muscle -m. vastus lateralis;
• c) the vastus medialis muscle -m.vastus medialis;
• d) the vastus intermedius muscle -m. vastus intermedius.
• The rectus femoris muscle arises from the anterior inferior iliac spine and
from the ilium above the acetabulum;
• The vastus lateralis muscle arises from the intertrochanteric line, from the
base of the greater trochanter and the lateral lip of the linea aspera;
• The vastus medialis muscle arises from the intertrochanteric line, and the
medial lip of the linea aspera;
• The vastus intermedius muscle arises from the anterior surface of the femur.
• Four heads unite to form a common tendon, which is inserted into the patella.
• Action. Extends the leg at the knee joint, flexes the thigh at hip joint.
• The posterior muscles of the thigh
• 1) The biceps femoris muscle -m. biceps femoris, has two heads:
• a) the long head -caput longus arises from the ischial tuberosity;
• b) the short head -caput breve arises from the lateral lip of the linea aspera.
• Two heads unite to form a common tendon and is attached to the head of the
fibula

Action. Extends the thigh at the hip joint; flexed and laterally rotates the leg at the
knee joint.
2) The semitendinosus muscle - m. semitendinosus, arises from the ischial
tuberosity and is attached to the tibial tuberosity.
Action. Extends the thigh at the hip joint; flexes and medially rotates the leg at knee
joint.
3) The semimembranosus muscle -m. semimembranosus, arises from the ischial
tuberos-ity and is attached to the medial condyle of the tibia and the fas-cia of the
popliteus muscle.
Action. Flexes and medially rotates the leg at the knee joint; extends the thigh at the
hip joint.
4) The popliteus muscle -m. popliteus, is a triangular muscle. It arises from the
lateral condyle of the femur and is attached to the posterior surface of the tibia above
the popliteal line.
• Action. Flexes and medially rotates the leg.
• The medial muscles of the thigh
• 1) The pectineus muscle -m. pectineus, arises from the superior branch and
crest of the pubis and is attached to the medial lip of the linea aspera.
• Action. Adducts and flexes the thigh at the hip joint.
• 2) The adductor longus muscle -m. adductor longus, is triangu-lar in shape.
It arises from the anterior surface of the superior branch of the pubis and is
attached to the medial lip of the linea aspera.
• Action. Adducts the thigh at the hip joint and assists in lateral rotation.
3) The adductor brevis muscle - m. adductor brevis, arises from the external surface
of the infe-rior branch of the pubis and is attached to the medial lip of the linea aspera.
Action. Adducts the thigh at the hip joint and assists in lateral rotation.
4) The adductor magnus mus-cle - m. adductor magnus, is a very large triangular
muscle. It arises from the external surface of the inferior ramus of the pu-bis, from
the ramus of the is-chium and the ischial tuberosity and is attached to the medial lip
of the linea aspera and the me-dial epicondyle of the femur.
Action. Adducts and extends the thigh at the hip joint.
5) The gracilis muscle -m. gracilis, arises from the exter-nal surface of the inferior
ramus of the pubis and the ramus of the ischium. It is attached to the tibial tuberosity.
• Action. Adducts the thigh at the hip joint and flexes the leg at the knee joint

Muscles of the leg

The muscles of the leg are divided into three groups:
1) the anterior muscles;
2) the lateral muscles;
3) the posterior muscles;

The anterior muscles of the leg

1) The tibialis anterior muscle -m. tibialis anterior, arises from the upper half of the
lateral surface of the tibia and the interosseus membrane and is attached to the medial
cuneiform bone and the base of the first metatarsal bone.
Action. Extends the foot at the ankle joint; it also assists in supination of the foot.
2) The extensor digitorum longus muscle -m. extensor digitorum longus, arises
from the upper end of the tibia, from the head of the fibula and from the in-terosseus
membrane.The tendons are attached to the middle and distal phalanx of

the II -IV toes.

Action. Extends the toes and extends the foot at the ankle joint.
3) The extensor hallucis longus -m. extensor hallucis longus, arises from the
middle half of the anterior surface of the fibula and the interosseus mem-brane and
is attached to the base of the distal phalanx of the big toe.
Action. Extends the big toe and extends the foot.
4) The peroneus tertius muscle -m. peroneus tertius, is part of the extensor
digitorum longus muscle. It arises from the anterior surface of the fibula and the
interosseus membrane and is at-tached to the medial side of the base of the fifth
metatarsal bone.
Action. Extends the foot.

The lateral muscles of the leg

1) The peroneus longus muscle -m. peroneus longus, arises from the head and
lateral surface of the fibula and from the lateral condyle of the tibia. It is attached to
the base of the first and second metatarsal bone and the cuneiform bone.
Action.Flexes and abducts the foot; it also assists in pronation of the foot.
2) The peroneus brevis muscle -m. peroneus brevis, arises from the lateral surface
of the fibula and is attached to the tubercle of the fifth metatarsal bone.
Action. Flexes and abducts the foot, also assists in the pronation of the foot.

The posterior muscles of the leg

1) The triceps surae muscle - m. triceps surae, has two parts:
a) the gastrocnemius muscle -m. gastrocnemius;
b) the soleus muscle –m. soleus.

The gastrocnemius muscle has two head:

1)the lateral head -caput lateralis arises from the lateral condyle of the femur;
2)the medial head -caput medialis arises from the popliteal surface of the femur
above the medial condyle.

The soleus muscle arises from the head and shaft of the fibula and from the linea
musculi soleus.
Two muscles unite to form a common tendon (Achilles tendon) and is attached to
the calcaneus tuber.
Action. Flexes the leg and foot; it also adducts the leg and assists in supination of the
foot.
2) The plantaris muscle -m. plantaris, has a small fusiform belly. The muscle may
be absent. It arises from the lateral epicondyle of the femur and is attached to the
posterior surface of the calcaneus.
Action. It is a feeble muscle. It assists in plantar flexing of the foot.
3) The flexor digitorum longus - m. flexor digitorum longus, arises from the mid-
dle part of the posterior surface of the tibia and is attached to the base distal pha-lanx
of the II -V phalanx.
Action. Flexes the distal phalanges of the four toes
(II -V).

4) The tibialis posterior muscle -m. tibialis posterior, arises from the posterior
surfaces of the tibia and fibula, and from the in-terosseus membrane. It is attached to
the scaphoid and cuneiform bones.
Action. Flexes and laterally rotates the foot.
5) The lexor hallucis longus mus-cle -m. lexor hallucis longus, arises from the
posterior surface of the fibula and the interosseus membrane an is attached to the
distal phalanx of the big toe.
Action. Flexes big toe and foot.

Muscles of the foot

The muscles of the foot are divided into two groups:
A) the dorsal muscles of the foot;
B) the plantar muscles of the foot.
A. The dorsal muscles of the foot
1) The extensor digitorum brevis muscle - m. flexor digitorum brevis, arises from
the anterior part of the up-per surface of the calcaneum and gives four tendons. These
tendons join with the long extensor tendons and are at-tached to the first, second,
third, and fourth toes.
Action. Extends the first, second, third, and fourth toes.

B. The plantar muscles of the foot

The muscles of the foot are divided into three groups:
1) Muscles of the big toe;
2) Muscles of the little toe;
3) Muscles of the sole.

The muscles of the big toe

1) The abductor hallucis muscle - m. abductor hallucis, arises from the medial
tubercle of the calcaneum and is attached to the medial side of the base of the
proximal phalanx of the big toe.
Action. Flexes and abducts the big toe.
2) The flexor hallucis brevis muscle -m. flexor hallucis brevis, arises from the
medial cuneiform bone and is attached to the base of the proximal phalanx of the big
toe.
Action. Flexes the proximal phalanx of the big toe.
3) The adductor hallucis muscle -m. adductor hallucis, has two heads:
a) oblique head - caput obliquum, arises from the lateral cuneiform bone and from
the base of the second and third metatarsal bones;

b) transverse head - caput transversum, arises from the capsules of the four lateral
metatarsophalangeal joints and the plantar ligament.
Two heads joins and is attached to the lateral side of the base of the proximal pha-
lanx of the big toe.
Action. Flexes and adducts the big toe.

The muscles of the little toe

1) The abductor digiti minimi muscle- m. abductor digiti minimi, arises from the
medial and lateral tubercles of the calcaneum and is attached to the tubercle of the
fifth toe and proximal phalanx of the fifth toe.
Action. Abducts the fifth toe and flexes the proximal phalanx of the fifth toe.
2) The flexor digiti minimi brevis muscle- m. flexor digiti minimi brevis, arises from
the base of the fifth metatarsal bone and is attached to the lateral side of the base of
the proximal phalanx of the little toe.
Action. Flexes the proximal phalanx of the little toe.
3) The opponens digiti minimi muscle - m. opponens digiti minimi, arises from the
base of the fifth metatarsal bone and is attached to the lateral side of the fifth
metatarsal bone.
Action. Opposes the little toe.

The muscles of the sole

1) The flexor digitorum brevis muscle -m. flexor digitorum brevis, arises from the
medial tubercle of the calcaneum. The muscle gives four tendons that pass to the
lateral toes and are attached to the middle phalanges of the corresponding toes.
Action. Flexes the four lateral toes (II -V).
2) The quadratus plantae (flexor digitorum accessorius) muscle -m. quadratus
plantae, arises from medial and lateral side of the calcaneum and is attached to the
posteriolateralis margin of the flexor digitorum longus.
Action. Flexes the lateral four toes.
3) The lumbricales muscles -mm. lumbricales, are four in number. They arise from
the tendons of the flexor digitorum longus muscle.
Each of them attached to the medial side of the dorsal expansion of extensor digi-
torum longus muscle and proximal phalanges of the lateral four toes.
Action. Flexes the four lat-eral toes.

4) The interosseus plan-tares muscles -mm. in-terosseus plantares, are three in

number and located between the four lateral metatarsal bones. They arise from the
inferior surfaces of the third, fouth, and fifth metatarsal bones and are attach to the
medial side of the bases of the phalanges and the dorsal expansion of the
corresponding toes.
Action. Adducts the toes; flexes the proximal phalanges.
5) The interosseus dorsalis muscles -mm. interosseus dorsalis, are four in number
and arise from the adjacent sides of the metatarsal bones. They attach to the bases of
the proximal phalanges; the first is attached to the medial side of the second toe and
the three others are inserted into the lateral sides of the second, third, and fourth toes.
Action. Abduct the toes, flex the proximal phalanges and extend the middle and distal
phalanges.
Fasciae of the lower limb and tendon sheath
The iliopsoas muscle is covered in the region of the abdomen by the fascia iliaca,
which is part of the common subperitoneal fascia (fascia subperitonealis). The
iliopsoas muscle attaches to the skeleton along the edges of the entire region
occupied by the iliopsoas muscle and thus forms a closed sheath for it. Below the
inguinal ligament, the fascia iliaca descends on the thigh, where it is continuous with
fascia lata investing the muscles of the thigh. Directly below the inguinal ligament,
within the boundaries of the femoral triangle, the fascia divides into two layers, deep
and superficial. The former passes behind the vessels of the thigh. The superficial
layer extends in front of the thigh vessels and lateral of the femoral vein and
terminates as a free falciform margin (marg falciformis).
This margin bounds a depression called the saphenous opening (hiatus saphenus) or
fossa ovalis. Two horns are distinguished in the falciform margin. Vena saphena
magna draining into the femoral vein overlaps the inferior horn (cornu inferius),
which blends with the deep layer pf fasciae latae. The superior horn (cornu superius)
attaches to the inguinal ligament and curving under it, fuses with the lacunar
ligament. Hiatus saphenus is covered by the cribriform fascia (fascia cribrosa) (the
subcutaneous tissue of the tight is pierced like a sieve by lymphatic vessels), which
grows into the falciform margin. Fascia lata, investing the muscles of the thigh, gives
of f processes, which pass deeply between the muscles and are attached to the bone.
Some of these processes are on the lateral part of the thigh and form the lateral
intermuscular septum (septum intermusculare femoris laterale). It is attached to the
lateral lip of the linea aspera femoris and separates m.vastus lateralis from the
posterior muscles of the thigh (m.biceps femoris in particular). The other, medial
intermuscular septum (septum intermusculare femoris mediale) is on the medial
aspect of the thigh and attaches on labium mediale lineae asperae in front of the
adductor muscles.
Besides, fascia lata separates into two layers along the edges of some of the muscles
to form a closed sheath for them. Fascia lata is very thick, particularly on the lateral
surface of the thigh, where tendinous fibres blend into it. Here it forms a wide
thickened band, the iliotibial tract (tractus iliotibialis) extending for the entire length
of the thigh. It serves as a tendon for the tensor muscle of the fascia lata and for the
gluteus maxinus muscle. In contrast to the tendinously thickened fascia on the
gluteus medius muscle (the proximal end of the iliotibial tract) the fascia covering
the gluteus maximus muscle is very thin. Distally, fascia lata extends to the anterior
surface of the knee and is continuous with the fascia of the leg; posteriorly it is
continuous with fascia poplitea covering the popliteal fossa and representing an
intermediate area between the fascia of the thigh and that of the leg. Thus, fascia lata
of the thigh differs in structure in its different parts: along with very strong areas (e.g.
the iliotibial tract) there are also weak areas (fascia cribrosa).
 The crural fascia (fascia cruris) surrounds the leg and fuses with the bones
where they are uncovered by muscles. On the posterior aspect of the leg, it consists
of a superficial and deep layers. The superficial layer covers the triceps surae muscle,
while the deep layer lies between this muscle and the deep posterior muscles and is
attached on the sides to the tibia and fibula. On the lateral side, fascia cruris gives off
two intermuscular septa, which penetrate deeply and attach to the fibula. The anterior
one (septum intermusculare anterius cruris) passes in front of the peroneus muscles,
while the posterior septum (septum intermusculare posterius cruris) stretches behind
them. On the anterior surface of the leg, above the malleoli, fibres blend with the
fascia to form a transverse band between the leg bones, the superior extensor
retinaculum of the foot (retinaculum mm.extensorum pedis superius). This ligament
presses the tendons of the anterior leg muscles to the bones. Of similar significance
is the inferior extensor retinaculum (retinaculum mm.extensorum inferius), located
distally in front of the ankle joint: it usually resembles in shape the latter Y laid on
its side. This ligament originates from the lateral surface of the calcaneus, and its
deep layer from the tarsal sinus, and then separates into two bands, the superior band
passes to the medial malleolus while the inferior attaches to the navicular and the
medial cuneiform bones. At places this ligament splits into a superficial and deep
layers investing the extensor tendons as a consequence of which four fibrous canals
(three for tendons and one for vessels). The extreme lateral and the widest canal
located under the common origin of the inferior extensor retinaculum, transmits the
tendons of the extensor digitorum longus and the peroneus tertius muscles. The canal
next to it transmits the tendon of the extensor hallucis longus muscle, while the third,
medial, canal transmits the tendon of the tibialis anterior muscle. The tendons passing
through the canals are invested in synovial sheaths. The fourth canal, located behind
the middle one, contains vessels (a. and v. dorsales pedis) and a nerve (n.peroneus
profundus). Thickenings of the fascia are also found behind both malleoli; they press
the tendons against the bones. The medial thickening forms a ligament, the flexor
retinaculum of the foot (retinaculum mm.flexorum pedis), which passes from the
calcaneus to the medial malleolus over the tendons of the tibialis posterior, flexor
digitorum longus, and flexor hallucis longus muscles. The ligament gives rise to a
septum that penetrates deeper and forms three osteofibrous canaks to transmit the
above-named tendons and one fibrous canal that lies closer to the surface to transmit
the posterior tibial artery and the tibial nerve. The tendons in the canals under the
ligament are invested in three separate sheaths. Behind the lateral malleolus is a
fascial thickening, the is a fascial thickening, the superior peroneal retinaculum
(retinaculum mm.peroneorum superius) stretching from the malleolus to the
calcaneus over the tendons of the peroneus longus and brevis muscles, which lie
under it in a common osteofibrous canal. Distally and somewhat downward both
tendons pass under another ligament, the inferior peroneal retinaculum (retinaculum
mm.peroneorum inferius) attached to the lateral surface of the calcaneus. The space
under the inferior peroneal retinaculum is divided by a septum into two canals
transmitting each tendon separately. The tendons of the peroneal muscles are
invested in a common synovial sheath, which divides distally into two parts
corresponding to the two canals under the inferior peroneal retinaculum. The dorsal
fascia of the foot (fascia dorsalis pedis) is rather thin distally from the inferior
extensor retinaculum and only on the level with the base of the first metatarsal bone
it has thickening of arched fibres passing over tendon of the extensor hallucis longus
muscle.
The fascia of the sole, like the fascia of the palm, is greatly thickened and forms in
its middle part a strong tendinous shining plantar aponeurosis (aponeurosis
plantaris), which stretches from the calcaneal tuberosity of the base of the toes and
is continuous proximally with the flexor digitorum brevis muscle which it covers.
Toward the toes, the aponeurosis expands and separates into five slips between which
transverse fibres pass. These slips terminate on the fibrous sheaths of the tendons on
the toes. Two vertical septa arise from the edges of the plantar aponeurosis, pass
upward between the muscles, and are attached to the deep fascia covering the
interosseous muscles. These septa divide the sole into three incompletely closed
compartments, which correspond on the whole to the three groups of muscles of the
sole. According to certain authors, three fascial septa are also distinguished: lateral,
medial, and intermediate. This is confirmed by the paths along which pus spreads on
the sole. Several sheaths investing the tendons are found on the sole. One of them,
the tendon sheath of the peroneus longus muscle (vagina tendinis m.peronei longi
plantaris), is lodged deep in the sole around the tendon of this muscle where the latter
passes in the groove of the cuboid bone under the long plantar ligament. The other
five sheaths (vaginae tendinum digitales pedis) invest the flexor tendons on the
plantar aspect of the toes and stretch from the region of the metatarsal heads to the
distal phalanges.

Topography of the lower limb

The piriform muscle passes through the greater sciatic foramen above and below
which narrow openings (foramen suprapiriforme and foramen infrapirifome) remain
and transmit the gluteal vessels and nerves. Sulcus obturatorius is supplemented
below by the obturator membrane and is thus converted to a canal (canalis
obturatorius) providing passage for the obturator vessels and nerves. The inguinal
ligament runs over the hip bone from the superior anterior iliac spine to the pubic
tubercle of the pubic bone and in this manner bounds the space between the above-
named bone and ligament. Fascia iliaca passing in this space fuses in its lateral part
with the inguinal ligament while its medial portion diverges from the ligament,
thickens, and attaches to the iliopubic eminence. The part of this thickened band of
fascia iliaca between the inguinal ligament and the iliopubic eminence is
distinguished artificially under the name of the iliopectineal arch (arcus
iliopectineus).
Arcus iliopectineus divides the entire space below the inguinal ligament into two
parts: a lateral, muscular part (lacuna musculorum) lodging the iliopsoas muscle and
the femoral nerve, and a medial, vascular part (lacuna vasorum) for passage of the
femoral artery and vein (the latter passes medially). From lacuna vasorum the vessels
pass to the thigh, leg, and foot. The vessels and nerves pass in grooves, which are
converted to canals and then again opened to form grooves. According to the passage
of the vessels and nerves, the following grooves (sulci) and canals are distinguished.
Sulcus iliopectineus, with which lacuna vasorum is continuous , lies between the
iliopsoas (laterally) and the pectineal (medially) muscles and is then in turn
continuous with sulcus femoralis anterior formed by the vastus medialis (laterally)
and the adductor longus and adductor magnus (medially) muscles. Both sulci are in
the femoral triangle (trigonum femorale) bounded by the inguinal ligament
(superiorly, the base of the triangle), the sartorius muscle (laterally) and the adductor
longus muscle (medially). The floor of the triangle, called fossa iliopectinea, is
formed by the iliopsoas and pectineal muscles. At the downward-facing apex of the
triangle, sulcus femoralis anterior leaves it between the muscles and transforms into
a canal, canalis adductoris, passing on the lower third of the thigh into the popliteal
fossa.
The canal is formed by the vastus medialis muscle (laterally), the adductor magnus
muscle (medially), and a tendinous lamina, lamina vastoadductoria, running over
them (anteriorly); its distal foramen is called hiatus tendineus (adductorius) formed
by the diverging bundles of the adductor magnus muscle.
The outlet, or external opening is the hiatus saphenus, bounded by the falciform
margin and its superior and inferior horns. The space between the openings is the
femoral canal (canalis femoralis), which has three walls: lateral, formed by the
femoral vein; posterior, formed by the deep layer of fascia lata femoris; and the
anterior wall, formed by the inguinal ligament and the superior horn of the crescent-
shaped margin of fascia lata. The latter is loosened in the hiatus saphenus and
perforated by lymph vessels and v.saphena magna as a consequence of which it
resembles a lattice and is called fascia cribrosa. Loosening of fascia lata femoris in
the oval fossa is responsible for the protrusion of a femoral hernia just in this space.
Canalis adductorius opens distally into the popliteal fossa (fossa poplitea) shaped
like a rhomb. The superior angle of the rhomb is formed by the biceps muscle
laterally and by the semimembranous and semitendinous muscles medially. The
inferior angle is bounded by both heads of the gastrocnemius muscle. The floor of
the fossa is formed by facies poplitea femoris and the posterior wall of the knee joint.
The popliteal fossa contains fatty tissue with the popliteal lymph nodes. From the
superior to the inferior angle pass the sciatic nerve (or its two branches into which it
divides) and the popliteal artery and vein in the following order (from the surface
and deeper): nerve, vein, artery.
The popliteal fossa is continuous with canalis cruropopliteus extending between the
superficial and deep layers of the posterior leg muscles and mainly formed by the
tibialis posterior (anteriorly) and the soleus (posteriorly) muscles. It provides passage
for the tibial nerve and the posterior tibial artery and vein. A branch of this canal
which corresponds to the course of the peroneal artery is canalis musculoperoneus
inferior formed by the middle third of the fibula and the flexor hallucis longus and
tibialis posterior muscles.
Canalis musculoperoneus superior is in the upper third of the leg, between the fibula
and the peroneus longus muscle; the superficial peroneal nerve passes in it. In line
with the course of the plantar vessels and nerves, two grooves are found on the sole
along the edges of the flexor digitorum brevis muscle: (1) a medial groove (sulcus
plantaris medialis) between the above indicated muscle and the abductor hallucis
muscle and (2) a lateral groove (sulcus plantaris lateralis) between the same flexor
and the abductor digiti minimi muscle.