Appendicular Muscles

MUSCUL AR SYSTEM
12 O U T L I N E
12.1 Muscles That Move the Pectoral Girdle and Upper

Limb 355
12.1a Muscles That Move the Pectoral Girdle 355
12.1b Muscles That Move the Glenohumeral Joint/Arm
12.1c Arm and Forearm Muscles That Move the
360
Appendicular
Elbow Joint/Forearm 363
12.1d Forearm Muscles That Move the Wrist Joint,
Hand, and Fingers 366
12.1e Intrinsic Muscles of the Hand 374
Muscles
12.2 Muscles That Move the Pelvic Girdle and Lower
Limb 377
12.2a Muscles That Move the Hip Joint/Thigh 377
12.2b Thigh Muscles That Move the Knee Joint/Leg 381
12.2c Leg Muscles 385
12.2d Intrinsic Muscles of the Foot 391
MODULE 6: MUSCUL AR SYSTEM
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Chapter Twelve Appendicular Muscles 355
he appendicular muscles control the movements of the upper 2. Identify the muscles that move the scapula and their actions.
T and lower limbs, and stabilize and control the movements
of the pectoral and pelvic girdles. These muscles are organized
3. Name the muscles of the glenohumeral joint, and explain
how each moves the humerus.
into groups based on their location in the body or the part of 4. Locate and name the muscles that move the elbow joint.
the skeleton they move. Beyond their individual activities, these 5. Identify the muscles of the forearm, wrist joint, fingers,
muscles also work in groups that are either synergistic or antago- and thumb.
nistic. Refer to figure 10.14 to review how muscles are named, and
Muscles that move the pectoral girdle and upper limbs are
recall the first Study Tip! from chapter 11 that gives suggestions
organized into specific groups: (1) muscles that move the pectoral
for learning the muscles.
girdle; (2) muscles that move the glenohumeral joint/arm; (3) arm
and forearm muscles that move the elbow joint/forearm; (4) fore-
arm muscles that move the wrist joint, hand, and fingers; and
12.1 Muscles That Move the Pectoral (5) intrinsic muscles of the hand. Some of these muscles are
superficial, and others are deep.
Girdle and Upper Limb
Learning Objectives: 12.1a Muscles That Move the Pectoral Girdle
1. Describe the major movements of the pectoral girdle and The muscles of the pectoral girdle originate on the axial skeleton
upper limb, and indicate the muscles involved for each and insert on the scapula and clavicle (figures 12.1 and 12.2).
movement. These muscles both stabilize the scapula and move it to increase
Superficial Deep
Trapezius
Deltoid (cut)
Subclavius
Deltoid Subscapularis
Pectoralis minor
Pectoralis major Pectoralis major (cut)
Deltoid (cut)
Teres major
Serratus anterior
Latissimus dorsi
Latissimus dorsi
Long head
Biceps brachii
Short head
Coracobrachialis
Anterior view
Figure 12.1
Anterior Muscles Associated with the Proximal Upper Limb. This anterior view compares some components of both the axial and
appendicular musculature. Only those muscles that move the upper limb are labeled. Superficial muscles are shown on the right side of the body,
and deep muscles are shown on the left side.
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356 Chapter Twelve Appendicular Muscles
Superficial Deep
Trapezius Levator scapulae

Rhomboid minor
Supraspinatus
Deltoid
Infraspinatus
Teres minor
Rhomboid major
Teres minor
Teres major Teres major
Serratus anterior
Latissimus dorsi
Serratus posterior inferior
External oblique
Posterior view
Figure 12.2
Posterior Muscles Associated with the Proximal Upper Limb. This posterior view compares some components of both the axial and
appendicular musculature. Only those muscles that move the upper limb are labeled. Superficial muscles are shown on the left, and deep muscles
are shown on the right.
classified according to their location in the thorax as either ante-

Study Tip! rior or posterior thoracic muscles.
The anterior thoracic muscles are the pectoralis minor,
When studying appendicular muscle function, remember these
serratus anterior, and subclavius (shown in figure 12.4a). The
two basic rules:
pectoralis minor is a thin, flat, triangular muscle deep to the pec-
1. If a muscle crosses over or spans a joint, it must move that toralis major. The muscle helps depress and protract (pull anteri-
joint. For example, since the biceps brachii crosses over the orly) the scapula. When your shoulders are hunched forward, the
elbow joint, it must move the elbow joint. pectoralis minor muscle is contracting. The serratus anterior is
2. Conversely, if a muscle doesn’t cross over or span a joint, it a large, flat, fan-shaped muscle positioned between the ribs and
cannot move that joint. For example, the deltoid is found the scapula. Its name is derived from the saw-toothed (serrated)
in the shoulder, and it does not cross over the wrist joint. appearance of its origins on the ribs. This muscle is the prime
Therefore, there is no possible way the deltoid can move the
wrist joint!
mover (agonist) in scapula protraction, and thus works with the
pectoralis minor. It is also the primary muscle that helps stabi-
If you can visualize where a muscle is located in your body, you lize the scapula against the posterior side of the rib cage and is
can usually figure out what type of movement the muscle performs. a powerful superior rotator of the scapula by moving the glenoid
cavity superiorly, as occurs when you abduct the upper limb. The
subclavius is a small, cylindrical muscle named for its location
the arm’s angle of movements. Some of the superficial muscles of inferior to the clavicle. It extends from the first rib to the clavicle,
the thorax are grouped together according to the scapular move- and its main action is to stabilize and depress the clavicle.
ment they direct: elevation, depression, protraction, or retraction The posterior thoracic muscles are the trapezius, levator scap-
(figure 12.3). The muscles that move the pectoral girdle are ulae, rhomboid minor, and rhomboid major (shown in figure 12.4b).
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Protractors
Pectoralis minor
Serratus anterior
Figure 12.3
Actions of Some Thoracic Muscles on the Scapula.
Retractors Individual muscles may contribute to different, multiple
Trapezius
Rhomboids actions. (a) The scapula can be retracted or protracted.
When you are standing upright and have good posture,
your scapulae are retracted. Conversely, poor posture
demonstrates scapular protraction. (b) Muscles that
elevate and depress the scapula. (c) Muscles that rotate
the scapula.
Retracted scapulae Protracted scapulae

(“good posture”) (“poor posture”)
(a) Retraction and protraction of scapula
Elevators Depressors Superior rotators Inferior rotators

Rhomboid major Trapezius (inferior part) Serratus anterior Rhomboid major
Rhomboid minor Pectoralis minor (not shown) Trapezius (superior part) Rhomboid minor
Levator scapulae Levator scapulae
Trapezius (superior part)
(b) Elevation and depression of scapula (c) Superior and inferior rotation of scapula
The trapezius is a large, flat, diamond-shaped muscle that As its name implies, its primary action is to elevate the scapula.
extends from the skull and vertebral column to the pectoral girdle It can also inferiorly rotate the scapula so that the glenoid cavity
laterally. In general, the trapezius can elevate, depress, retract, or points inferiorly.
rotate the scapula, depending upon which fibers of the muscle are Both the rhomboid minor and the rhomboid major are
actively contracting. The superior fibers of the trapezius elevate located deep to the trapezius. These rhomboid muscles are paral-
and superiorly rotate the scapula. The middle fibers work with lel bands that run inferolaterally from the vertebrae to the scap-
the rhomboid muscles to retract the scapula, while the inferior ula. Often they are indistinct from each other. They help elevate
fibers depress the scapula. and retract (adduct) the scapula, as when you stand up straight
The levator scapulae is a narrow, elongated muscle that is with your shoulders back. The rhomboid muscles also inferiorly
deep to both the trapezius and sternocleidomastoid muscles. It rotate the scapula.
originates from multiple heads on the transverse processes of the Table 12.1 summarizes the characteristics of the thoracic
cervical vertebrae and inserts on the superior angle of the scapula. muscles that move the pectoral girdle.
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Superficial Deep
Sternocleidomastoid
Subclavius
Subscapularis
Deltoid
Coracobrachialis
Pectoralis minor
Pectoralis major
Serratus anterior
Biceps brachii,
long head
Sternocleidomastoid
Subclavius
Deltoid
Subscapularis
Coracobrachialis
Pectoralis major
Pectoralis minor
Biceps brachii, Serratus anterior

long head
(a) Anterior view

Figure 12.4
Muscles That Move the Pectoral Girdle and the Glenohumeral Joint/Arm. Illustrations and cadaver photos show (a) anterior and (b) posterior
views of the muscles whose primary function is to move the pectoral girdle (scapula or clavicle), labeled in bold. Muscles that attach to the pectoral girdle
but primarily move the arm are labeled but not in bold. Superficial muscles are shown on the right side of the body and deep muscles on the left.
CLINICAL VIEW
Paralysis of the Serratus Anterior anterior is the primary protractor of the scapula, and under normal circum-
stances, its pull on the scapula is counterbalanced by the posterior thoracic
Muscle (“Winged Scapula”) (superficial back) muscles. Paralysis of the serratus anterior muscle leaves
The serratus anterior muscle receives its innervation from the long thoracic the posterior thoracic muscles unopposed. If a patient with this condition
nerve, which travels inferiorly along the anterolateral chest wall. Because of puts both arms anteriorly on a wall and then pushes, the scapula on the
its location, the long thoracic nerve is occasionally damaged or cut during injured side will poke posteriorly like a bird’s wing, a classic sign known as
surgical removal of the breast (radical mastectomy). Damage to this nerve the “winged scapula.” The scapula on the unaffected side will remain in the
causes paralysis of the serratus anterior muscle. Recall that the serratus expected anatomic position, close to the thoracic wall.
358
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Superficial Deep
Levator scapulae
Trapezius
Rhomboid minor Supraspinatus
Rhomboid major Infraspinatus
Deltoid Teres minor
Teres major
Latissimus dorsi
Trapezius
Levator scapulae
Rhomboid minor
Supraspinatus
Rhomboid major
Infraspinatus
Deltoid
Teres minor
Teres major
Serratus anterior
Latissimus dorsi
(b) Posterior view
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Table 12.1 Thoracic Muscles That Move the Pectoral Girdle

Group/Muscle Actions Origin/Insertion Innervation
ANTERIOR MUSCLES
Pectoralis minor Protracts and depresses scapula O: Ribs 3–5 Medial pectoral nerve (C8–T1)
(pek ́tō-ra ́lis mı̄ ́ner) I: Coracoid process of scapula
pectus = chest
Serratus anterior (ser-ā ́tŭs Prime mover in scapula protraction; O: Ribs 1–8, anterior and superior Long thoracic nerve (C5–C7)
an-tēr ́ē-ōr) superiorly rotates scapula (so margins
serratus = saw glenoid cavity moves superiorly); I: Medial border of scapula, anterior
stabilizes scapula surface
Subclavius (sŭb-klā ́vē-ŭs) Stabilizes and depresses clavicle O: Rib 1 Nerve to subclavius (C5–C6)
sub = under I: Inferior surface of clavicle
clav = clavicle
POSTERIOR MUSCLES
Levator scapulae (lē-vā ́tor, le-vā ́ter Elevates scapula; inferiorly rotates O: Transverse processes of C1–C4 Cervical nerves (C3–C4) and dorsal
skap ́ū-lé) scapula (pulls glenoid cavity I: Superior part of medial border of scapular nerve (C5)
levator = raises inferiorly) scapula
Rhomboid major (rom ́boyd mā ́jŏr) Elevates and retracts (adducts) O: Spinous processes of T2–T5 Dorsal scapular nerve (C5)
rhomboid = diamond-shaped scapula; inferiorly rotates scapula I: Medial border of scapula from
spine to inferior angle
Rhomboid minor Elevates and retracts (adducts) O: Spinous processes of C7–T1 Dorsal scapular nerve (C5)
scapula; inferiorly rotates scapula I: Medial border of scapula superior
to spine
Trapezius (tra-pē ́zē-ŭs) Superior fibers: Elevate and O: Occipital bone (superior nuchal Accessory nerve (CN XI)
trapezion = irregular four-sided superiorly rotate scapula line); ligamentum nuchae;
figure Middle fibers: Retract scapula spinous processes of C7–T12
Inferior fibers: Depress scapula I: Clavicle; acromion process and
spine of scapula
12.1b Muscles That Move the Glenohumeral brachii originates on the supraglenoid tubercle of the scapula
Joint/Arm and inserts on the radial tuberosity. This portion of the muscle
assists in flexing the arm. The long head of the triceps bra-
The phrases “moving the glenohumeral joint” and “moving the
chii originates on the infraglenoid tubercle of the scapula and
arm or humerus” mean the same thing. A movement such as
inserts on the olecranon of the ulna. This part of the muscle
flexion of the arm requires movement at the glenohumeral joint.
helps extend and adduct the arm.
Throughout this text, we refer to both the joint (where the move-
The seven remaining muscles that move the humerus at
ment is occurring) and the body region (that is being moved) to
the glenohumeral joint are termed the scapular muscles, because
minimize any confusion you may have.
they originate entirely on the scapula. These muscles include the
The glenohumeral joint is crossed by 11 muscles that insert
deltoid, coracobrachialis, teres major, and the four rotator cuff
on the arm (humerus) or the forearm (radius and ulna) (see figure
muscles. The deltoid is a thick, powerful muscle that functions as
12.4). Two of these muscles, the latissimus dorsi and pectoralis
a prime abductor of the arm and forms the rounded contour of the
major, are the primary attachments of the arm to the trunk, and
shoulder. Note that the fibers of the deltoid originate from three
they are the prime movers of the glenohumeral joint. The latis-
different points, and these different fiber groups all perform dif-
simus dorsi is a broad, triangular muscle located on the inferior
ferent functions: (1) The anterior fibers flex and medially rotate
part of the back. Often, it is referred to as the “swimmer’s muscle,”
the arm. (2) The middle fibers abduct the arm; in fact, the deltoid
because many of its actions are required for certain swimming
is the prime abductor of the arm. (3) The posterior fibers extend
strokes. It is the prime arm extensor, and also adducts and medi-
and laterally rotate the arm. The coracobrachialis works as a
ally rotates the arm. The pectoralis major is a large, thick, fan-
shaped muscle that covers the superior part of the thorax. It is the
principal flexor of the arm, and also adducts and medially rotates
the arm. Although these muscles are antagonists with respect to
arm flexion and extension, they work together (synergistically)
when performing other movements, such as adducting and medi-
Study Tip!
ally rotating the humerus. Generally speaking, muscles that originate anterior to the
The biceps brachii and triceps brachii, discussed in detail glenohumeral joint flex the arm (move it anteriorly), and those that
with the muscles that move the elbow joint, also cross the originate posterior to the joint extend the arm (move it posteriorly).
glenohumeral joint. Specifically, the long head of the biceps
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Clavicle
Acromion
Supraspinatus Supraspinatus
Coracoid process
Subscapularis Infraspinatus
Teres minor
Humerus
(a) Anterior view (b) Posterior view
Subscapularis Supraspinatus Infraspinatus and teres minor

(c) Movement of rotator cuff muscles
Figure 12.5
Rotator Cuff Muscles. The rotator cuff muscles reinforce the glenohumeral joint and secure the head of the humerus in the glenoid cavity.
(a) The subscapularis is best seen in an anterior view of the right shoulder. (b) The supraspinatus, infraspinatus, and teres minor are best seen in
a posterior view. (c) The subscapularis medially rotates the humerus (as when winding up for a pitch), the supraspinatus abducts the humerus (as
when executing the pitch), and the infraspinatus and teres minor laterally rotate the humerus (as when completing the pitch and slowing down the
pitching arm).
synergist to the pectoralis major in flexing and adducting the arm. Table 12.2 summarizes the characteristics of the muscles
The teres major works synergistically with the latissimus dorsi by that move the glenohumeral joint and arm.
extending, adducting, and medially rotating the arm.
Four rotator cuff muscles (subscapularis, supraspinatus, W H AT D O Y O U T H I N K ?
infraspinatus, and teres minor) provide strength and stability to
the glenohumeral joint (figure 12.5). These muscles attach the ●
1 Which rotator cuff muscle tends to suffer the most injuries,
and why?
scapula to the humerus. The specific movements of each muscle
are best learned when equating them to pitching a ball:
■ The subscapularis is used when you wind up for a pitch. It
medially rotates the arm.
■ The supraspinatus is used when you start to execute the
Study Tip!
pitch, by fully abducting the arm. The four rotator cuff muscles also make up the acronym SITS:
■ The infraspinatus and teres minor help slow down the Supraspinatus, Infraspinatus, Teres major, and Subscapularis.
pitching arm upon completion of the pitch. These two
muscles adduct and laterally rotate the arm.
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CLINICAL VIEW
Rotator Cuff Injuries This syndrome is especially common in baseball players because the
repetitive shoulder movements while pitching and throwing the ball
A rotator cuff injury is the result of trauma or disease to any can pinch (impinge) the supraspinatus tendon against the acromion.
portion of the rotator cuff musculature or tendons. Extensive use A person who sustains a rotator cuff injury almost immediately feels
of the rotator cuff muscles can cause tearing of muscle fibers or a sharp pain in the shoulder region. Typically, severe rotator cuff
rupture of tendon attachments. Injury to the supraspinatus muscle injuries require surgical repair. Even after surgery, some individuals
is most common never regain full athletic use of the injured shoulder.
Table 12.2 Muscles That Move the Glenohumeral Joint/Arm

Group/Muscle Action Origin/Insertion Innervation
MUSCLES ORIGINATING ON AXIAL SKELETON
Latissimus dorsi (lă-tis ́i-mŭs dōr ́sı̄) Prime mover of arm extension; also O: Spinous processes of T7–T12; ribs Thoracodorsal nerve (C6–C8)
latissimus = widest adducts and medially rotates arm 8–12; iliac crest; thoracolumbar
dorsi = back (“swimmer’s muscle”) fascia
I: Intertubercular groove of
humerus
Pectoralis major (pek ́tō-ră ́lis Prime mover of arm flexion; also O: Medial clavicle; costal cartilages Lateral pectoral (C5–C7) and medial
mā ́jŏr) adducts and medially rotates arm of ribs 2–6; body of sternum pectoral (C8–T1) nerves
I: Lateral part of intertubercular
groove of humerus
MUSCLES ORIGINATING ON SCAPULA
Deltoid (del ́toyd) Anterior fibers: Flex and medially O: Acromial end of clavicle; Axillary nerve (C5–C6)
delta = triangular rotate arm acromion and spine of scapula
Middle fibers: Prime mover of arm I: Deltoid tuberosity of humerus
abduction
Posterior fibers: Extend and laterally
rotate arm
Coracobrachialis (kōr ́ă-kō-brā-kē-a ́lis) Adducts and flexes arm O: Coracoid process of scapula Musculocutaneous nerve (C5–C6
coraco = coracoid I: Middle medial shaft of humerus fibers)
brachi = arm
Teres major (ter ́ēz, tēr ́ēz, mā ́jŏr) Extends, adducts, and medially O: Inferior lateral border and Lower subscapular nerve (C5–C6)
teres = round rotates arm inferior angle of scapula
I: Lesser tubercle and
intertubercular groove of
humerus
Triceps brachii (long head) (trı̄ ́seps Extends and adducts arm O: Infraglenoid tubercle of scapula Radial nerve (C5–C7 axons)
brā ́kē-ı̄) I: Olecranon process of ulna
triceps = three heads
Biceps brachii (long head) (bı̄ ́seps) Flexes arm O: Supraglenoid tubercle of scapula Musculocutaneous nerve (C5–C6
I: Radial tuberosity and bicipital fibers)
aponeurosis
Rotator cuff muscles (rō-tā ́tōr kŭf) Collectively, these four muscles
rotatio = to revolve stabilize the glenohumeral joint
Subscapularis (sŭb-skap-ū-lār ́ris) Medially rotates arm O: Subscapular fossa of scapula Upper and lower subscapular nerves
sub = under I: Lesser tubercle of humerus (C5–C6)
Supraspinatus (soo-pră-spı̄-nā ́tŭs) Abducts arm O: Supraspinous fossa of scapula Suprascapular nerve (C5–C6)
supra = above, over I: Greater tubercle of humerus
spin = spine
Infraspinatus (in-fră-spı̄-nā ́tŭs) Adducts and laterally rotates arm O: Infraspinous fossa of scapula Suprascapular nerve (C5–C6)
infra = below I: Greater tubercle of humerus
Teres minor Adducts and laterally rotates arm O: Upper dorsal lateral border of Axillary nerve (C5–C6)
scapula (superior to teres major
origin)
I: Greater tubercle of humerus
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Table 12.3 Summary of Muscle Actions at the Glenohumeral Joint/Arm

Abduction Adduction Extension Flexion Lateral Rotation Medial Rotation
Deltoid (middle fibers) Latissimus dorsi Latissimus dorsi Pectoralis major Infraspinatus Subscapularis
Supraspinatus Pectoralis major Deltoid (posterior Deltoid (anterior Teres minor Deltoid (anterior fibers)
fibers) fibers)
Coracobrachialis Teres major Coracobrachialis Deltoid (posterior Latissimus dorsi
fibers)
Teres major Long head of triceps (Long head of biceps Pectoralis major
brachii brachii)
Teres minor Teres major
Infraspinatus
Boldface indicates a prime mover; others are synergists. Parentheses around an entire muscle name indicate only a slight effect.
12.1c Arm and Forearm Muscles That Move

Study Tip! the Elbow Joint/Forearm
The best way to remember the appendicular muscles is to group When you move the elbow joint, you move the bones of the
muscles that have similar functions. Note that a muscle that has mul- forearm. Thus, the term “flexing the elbow joint” is synonymous
tiple functions is in more than one group. The muscles that move the with “flexing the forearm.” Keep this in mind as we discuss the
arm at the glenohumeral joint are grouped in table 12.3 according to muscles that move the elbow joint and forearm.
different types of actions. We recommend that you copy the columns The muscles in limbs are organized into compartments,
multiple times and then test your knowledge by trying to write out which are surrounded by deep fascia. Each compartment houses
all of the muscles in a group without looking at your notes. If you functionally related skeletal muscles, as well as their associ-
can list them all, you truly remember the information! ated nerves and blood vessels. The muscles of the arm may be
subdivided into an anterior compartment and a posterior com-
partment (figure 12.6). The anterior compartment primarily
contains elbow flexors, and the posterior compartment contains
W H AT D I D Y O U L E A R N?
elbow extensors, so these compartments are also called the flexor
●
1 What muscles are you using when you protract the scapula? compartment and the extensor compartment, respectively.
●
2 What is the primary action of the levator scapulae? On the anterior side of the humerus are the principal flexors
of the forearm: the biceps brachii and the brachialis
●
3 What muscles cause medial rotation of the arm? (figure 12.7). The biceps brachii is a large, two-
●
Anterior
4 How can the deltoid extend and flex the arm? headed muscle on the anterior surface of the
Biceps brachii
View of
cross
section Brachialis
Anterior
Lateral Medial compartment of arm
Humerus
Posterior
compartment Medial head
of arm Triceps Lateral head Figure 12.6
brachii Actions of Arm Muscles on
Long head
the Forearm. A cross-sectional
view shows the compartments of
the right arm. The anterior and
posterior compartment muscles
are responsible for different
movements.
Posterior
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Deltoid
Pectoralis major
Coracobrachialis
Biceps brachii,
long head
Biceps brachii,
short head
Triceps brachii
Cephalic vein
Brachialis
Brachioradialis
Bicipital aponeurosis
(a) Anterior view
Superficial Deep
Coracoid process
Coracobrachialis
Biceps brachii, long head
Biceps brachii, short head
Brachialis
Biceps brachii tendon

Coronoid process
Radial tuberosity of ulna
(b) Anterior muscles

Figure 12.7
Anterior Muscles That Move the Elbow Joint/Forearm. (a) Illustration and cadaver photo of the right arm and shoulder show the muscles that
produce movements at the elbow joint, labeled in bold. (b) Superficial and deep anterior arm muscles.
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Supraspinatus
Deltoid
Infraspinatus
Teres minor
Teres major
Triceps brachii
Lateral head
Long head
Latissimus dorsi
Anconeus
(a) Posterior view
Superficial Deep Figure 12.8

Posterior Muscles That Move the Elbow Joint/
Forearm. (a) Illustration and cadaver photo of
the right arm and shoulder show the muscles that
Infraglenoid produce movements at the elbow joint, labeled
tubercle in bold. (b) Superficial and deep posterior arm
muscles.
Long head
Lateral head
Triceps brachii, medial head

Triceps brachii
Medial head
Triceps brachii tendon (cut)
Triceps brachii tendon
Olecranon of ulna
Anconeus
(b) Posterior muscles
humerus. The biceps brachii flexes the forearm and is a powerful erful flexor of the forearm at the elbow. The brachioradialis is a
supinator of the forearm when the elbow is flexed. (An example of prominent muscle on the lateral surface of the forearm. It is a syner-
this supination movement occurs when you tighten a screw with gist in forearm flexion, effective primarily when the prime movers of
your right hand.) The tendon of the long head of the biceps brachii forearm flexion have already partially flexed the elbow.
crosses the shoulder joint, and so this muscle helps flex the humerus The posterior compartment of the arm contains two mus-
as well (albeit weakly). The brachialis is deep to the biceps brachii cles that extend the forearm at the elbow: the triceps brachii and
and lies on the anterior surface of the humerus. It is the most pow- the anconeus (figure 12.8). The triceps brachii is the large,
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Figure 12.9 Medial

Forearm Muscles That Supinate and Pronate. A view of the epicondyle
right upper limb shows the supinator muscle supinates the forearm,
Lateral
while the pronator teres and pronator quadratus pronate the forearm. epicondyle
(The biceps brachii, an arm muscle not shown here, also supinates
the forearm.) Supinator
Pronator
teres
three-headed muscle on the posterior surface of the arm. It is Interosseous

the prime extensor of the forearm, and so its action is antagonis- membrane
tic to that of the biceps brachii. Only the long head of the triceps
brachii crosses the glenohumeral joint, where it helps extend
the humerus. All three parts of this muscle merge to form a Pronator
common insertion on the olecranon of the ulna. A weak elbow quadratus
extensor is the small anconeus that crosses the posterolateral
region of the elbow.
W H AT D O Y O U T H I N K ?
●
2 The brachialis is on the anterior surface of the arm. Without
looking at the muscle tables, determine whether this muscle flexes
or extends the elbow joint. How did you reach your conclusion?
Some forearm muscles pronate or supinate the forearm

(figure 12.9). As their names imply, both the pronator teres
and the pronator quadratus rotate the radius across the surface
of the ulna to pronate the forearm. These muscles are located in
the anterior compartment of the forearm. They are antagonistic to
the supinator in the posterior compartment of the forearm. The Supination Pronation
supinator works synergistically with the biceps brachii to supinate
the forearm.
Table 12.4 summarizes the characteristics of the muscles
that move the forearm, and table 12.5 groups them according to
common function. By learning these muscles as groups, you will
have a better understanding of how they work together to perform Deep fascia partitions the forearm muscles into an anterior
specific functions. (flexor) compartment and a posterior (extensor) compartment
(figure 12.10). Most of the anterior compartment muscles
12.1d Forearm Muscles That Move the originate on the medial epicondyle of the humerus via a com-
Wrist Joint, Hand, and Fingers mon flexor tendon. Muscles in the anterior compartment of the
Most muscles in the forearm move the hand at the wrist and/or the forearm tend to flex the wrist, the metacarpophalangeal (MP)
fingers. These muscles are called extrinsic muscles of the wrist and joints, and/or the interphalangeal (IP) joints of the fingers.
hand, because the muscles originate on the forearm, not the wrist Most of the posterior compartment muscles originate on the
or hand. Palpate your own forearm; it is bigger near the elbow lateral epicondyle of the humerus via a common extensor ten-
because the bellies of these forearm muscles form the bulk of this don. Muscles in the posterior compartment of the forearm tend
region. Moving toward the wrist, the forearm thins because there to extend the wrist, the MP joints, and/or the IP joints.
are no longer big muscle bellies, but rather the long tendons that Note that not all anterior forearm muscles cause flexion.
project from these muscles. Both the pronator teres and the pronator quadratus, discussed
mck78097_ch12_354-396.indd 366 2/14/11 3:25 PM

Table 12.4 Muscles That Move the Forearm

Muscle Action Origin/Insertion Innervation
FLEXORS (ANTERIOR ARM)
Biceps brachii (bı̄ ́seps brā ́kē-ı̄) Flexes forearm, powerful supinator O: Long head: Supraglenoid tubercle Musculocutaneous nerve
biceps = two heads of forearm of scapula (C5–C6 fibers)
Long head Long head flexes arm Short head: Coracoid process of
scapula
Short head
I: Radial tuberosity and bicipital
aponeurosis
Brachialis (brā ́kē-al ́is) Primary flexor of forearm O: Distal anterior surface of Musculocutaneous nerve
humerus (C5–C6 fibers)
I: Tuberosity and coronoid process
of ulna
Brachioradialis Flexes forearm O Lateral supracondylar ridge of Radial nerve (C6–C7 fibers)
(brā ́kē-ō-rā ́dē-al ́is) humerus
I: Styloid process of radius
EXTENSORS (POSTERIOR ARM)
Triceps brachii (trı̄ ́seps brā ́kē-ı̄) Primary extensor of forearm O: Long head: Infraglenoid tubercle Radial nerve (C5–C7 fibers)
Long head Long head of triceps also extends of scapula
Lateral head and adducts arm Lateral head: Posterior humerus
above radial groove
Medial head
Medial head: Posterior humerus
below radial groove
I: Olecranon of ulna
Anconeus (ang-kō ́nē-ŭs) Extends forearm O: Lateral epicondyle of humerus Radial nerve (C6–C8 fibers)
ankon = elbow I: Olecranon of ulna
PRONATORS (ANTERIOR FOREARM MUSCLES)
Pronator quadratus Pronates forearm O: Distal one-fourth of ulna Median nerve (C8–T1 fibers)
(prō-nā ́tōr kwah-drā ́tŭs) I: Distal one-fourth of radius
Pronator teres (prō-nā ́tōr ter ́ēz) Pronates forearm O: Medial epicondyle of humerus Median nerve (C6–C7 fibers)
and coronoid process of ulna
I: Lateral surface of radius
SUPINATOR (POSTERIOR FOREARM MUSCLE)
Supinator (soo ́pi-nā-tōr) Supinates forearm O: Lateral epicondyle of humerus Radial nerve (C6–C8 fibers)
and ulna distal to radial notch
I: Anterolateral surface of radius
distal to radial tuberosity
Table 12.5 Summary of Muscle Actions at the Elbow Joint/Forearm

Extension Flexion Pronation Supination
Triceps brachii Brachialis Pronator teres Biceps brachii
(Anconeus) Biceps brachii Pronator quadratus Supinator
Brachioradialis
Boldface indicates a prime mover; others are synergists. Parentheses indicate only a slight effect.
previously, are located in the anterior compartment of the forearm, The tendons of forearm muscles typically are surrounded
although their primary function is pronation. Likewise, the supi- by tendon (synovial) sheaths and held adjacent to the skeletal ele-
nator muscle is in the posterior compartment of the forearm, even ments by strong fascial structures. At the wrist, the deep fascia
though its primary function is supination. of the forearm forms thickened, fibrous bands termed retinacula.
mck78097_ch12_354-396.indd 367 2/14/11 3:25 PM

Anterior
Anterior compartment
of forearm
View of Palmaris longus

cross Flexor carpi radialis
section
Flexor digitorum superficialis
Brachioradialis Flexor carpi ulnaris
Flexor digitorum profundus
Extensor carpi radialis Flexor pollicis longus
longus Radius
Extensor carpi radialis

brevis Ulna
Lateral Medial
Abductor pollicis longus

Extensor pollicis longus
Extensor digitorum
Extensor digiti minimi
Extensor carpi ulnaris
Posterior
Figure 12.10
Actions of Muscles of the Forearm. A cross-sectional view of the right forearm shows the
Posterior
compartments. The muscles of the anterior and posterior compartments cause different movements.
compartment of forearm
The retinacula help hold the tendons close to the bone and pal bones and the flexor retinaculum, which is called the carpal
prevent the tendons from “bowstringing” outward. The palmar tunnel. The extensor retinaculum is superficial to the dorsal sur-
(anterior) surface of the carpal bones is covered by the flexor face of the carpal bones. Extensor tendons of the wrist and digits
retinaculum (figure 12.11a). Flexor tendons of the digits and pass between the carpal bones and the extensor retinaculum.
the median nerve pass through the tight space between the car- The muscles of the anterior compartment of the forearm
may be subdivided into a superficial layer, an intermediate layer,
and a deep layer. The superficial and intermediate muscles origi-
nate from the common flexor tendon that attaches to the medial
epicondyle of the humerus. The deep layer of muscles originates
CLINICAL VIEW directly on the forearm bones.
The superficial layer of anterior forearm muscles is arranged
Lateral Epicondylitis from the lateral to the medial surface of the forearm in the fol-
(“Tennis Elbow”) lowing order: pronator teres (described previously with muscles
that move the forearm), flexor carpi radialis, palmaris longus, and
Lateral epicondylitis (ep ́ i-kon-di-lı̄ ́t is), or “tennis elbow,” is flexor carpi ulnaris (figure 12.11a).
a painful condition resulting from trauma or overuse of the com- The flexor carpi radialis extends diagonally across the ante-
mon extensor tendon of the posterior forearm muscles. Although rior surface of the forearm. Its tendon is prominent on the lateral
the pain is perceived as coming from the elbow joint, it actually side of the forearm. This muscle flexes the wrist and abducts the
arises from the lateral epicondyle of the humerus, the attachment hand at the wrist. The palmaris longus is absent in approximately
site of the common extensor tendon. Lateral epicondylitis most 10% of all individuals. This narrow, superficial muscle on the
often results from the repeated forceful contraction of the forearm anterior surface of the forearm weakly assists in wrist flexion. On
extensors. These are the muscles used to extend the hand at the the anteromedial side of the forearm, the flexor carpi ulnaris is
wrist, as when pulling a heavy object from an overhead shelf, positioned to both flex the wrist and adduct the hand at the wrist.
shoveling snow, or hitting a backhand shot in tennis. You can determine the positioning of the three superficial
muscles of the anterior forearm and the pronator teres muscle on
mck78097_ch12_354-396.indd 368 2/14/11 3:25 PM

Medial epicondyle
Medial epicondyle Common flexor tendon

Common flexor tendon Pronator teres
Pronator teres
Brachioradialis Flexor carpi radialis
Flexor carpi ulnaris
Palmaris longus
Palmaris longus
Brachioradialis
Flexor carpi radialis
Flexor carpi ulnaris
Flexor
retinaculum
Palmar aponeurosis
Flexor
retinaculum
Palmar aponeurosis
(a) Right anterior forearm, superficial view Figure 12.11

Anterior Forearm Muscles. The anterior
forearm muscles pronate the forearm or
flex the wrist and fingers. They may be
subdivided into superficial, intermediate,
and deep groups. (a) Illustration and
Supinator cadaver photo show the superficial
Ulna muscles of the right anterior forearm.
Radius
(b) Intermediate and (c) deep muscles of
the right anterior forearm.
Flexor digitorum Flexor digitorum profundus

superficialis
Flexor pollicis
longus
Pronator
quadratus
Flexor digitorum
profundus tendons
Flexor digitorum
superficialis tendons
Flexor digitorum
profundus tendons
(b) Right anterior forearm, intermediate view (c) Right anterior forearm, deep view
mck78097_ch12_354-396.indd 369 2/14/11 3:25 PM

CLINICAL VIEW
Carpal Tunnel Syndrome develop carpal tunnel syndrome as increased water retention results
in compression within the carpal tunnel.
The flexor retinaculum extends from the medial carpal bones to the lateral
Carpal tunnel syndrome is characterized by pain and paresthesia
carpal bones, and the space between the carpal bones and the flexor reti-
(par-es-thē ́zē-ă; aisthesis = sensation), which is the feeling of
naculum is the carpal tunnel. Through this narrow tunnel, numerous long
“pins and needles.” Sometimes, there is more extensive sensory
muscle tendons extend to the fingers from the forearm. Accompanying
loss as well as motor loss in the muscles of the hand supplied by
these tendons is the median nerve, which innervates the skin on the
the median nerve. The median nerve supplies the muscles of the
lateral region of the hand and the muscles that move the thumb.
thumb, so in severe cases of carpal tunnel syndrome, these muscles
Any compression of either the median nerve or the tendons in the tunnel may atrophy as their nerve supply is diminished. Treatment of the
results in carpal tunnel syndrome. A common cause is inflammation syndrome includes supporting the hand in a splint and administering
of any component in the carpal tunnel—for example, swollen tendons anti-inflammatory drugs (e.g., ibuprofen or prescription medicine).
as a result of overuse. Workers who repeatedly flex either their fingers In severe, chronic cases that do not respond to more conservative
or wrists, such as typists and computer programmers, experience this treatment, a surgeon can incise the flexor retinaculum and open the
condition. In addition, females in their last trimester of pregnancy may carpal tunnel, relieving the pressure.
Flexor pollicis longus tendon Flexor digitorum superficialis tendon

Palmaris longus tendon (cut) Flexor digitorum profundus tendon
Median nerve
Common flexor synovial sheath
Flexor carpi radialis tendon
Flexor retinaculum covering carpal

tunnel
Trapezium
Common flexor synovial sheath
(a) Carpal tunnel, anterior view
View of
cross Anterior
section
Palmaris longus tendon
Median nerve Flexor retinaculum

covering carpal tunnel
Flexor digitorum
Flexor carpi radialis tendon superficialis tendons
Flexor pollicis longus tendon
Carpal tunnel
Common flexor
synovial sheath
Flexor digitorum
profundus tendons
Trapezium
Hamate
Trapezoid Capitate
Posterior
(b) Carpal tunnel, transverse section
mck78097_ch12_354-396.indd 370 2/14/11 3:25 PM

CLINICAL VIEW
Prona
tor ter
es
Anatomic Snuffbox
Flexor
carpi ra
dialis The anatomic snuffbox is a triangular region on the postero-
Palmari
s longu
s lateral side of the hand, just proximal to the thumb. This region is
Flexor carpi uln
aris bounded by the three tendons of the deep posterior compartment
muscles of the forearm: (1) abductor pollicis longus, (2) exten-
(Left hand covers
sor pollicis brevis, and (3) extensor pollicis longus. This area is
medial epicondyle)
termed the anatomic snuffbox because in historical times, such
Figure 12.12 as during the American Revolution, people put finely ground
Positioning of the Superficial Anterior Forearm Muscles. tobacco called snuff in this little depression and then inhaled it.
By positioning the left hand at the medial epicondyle of the right The floor of the snuffbox is formed by the scaphoid bone. This
humerus, fingers 2–5 lay in the approximate position of the fact has diagnostic importance, because a person who fractures
superficial muscles of the anterior forearm. the scaphoid bone experiences extreme localized tenderness in
the region of the anatomic snuffbox.
Extensor pollicis longus tendon

your own body by performing the exercise shown in figure 12.12.
Wrap your thumb around the medial epicondyle of the other arm,
so your thumb is positioned posterior to the elbow. Align your
little finger along the medial border of your forearm. The natu-
ral placement of your four fingers, from your index finger to
your little finger, overlies the placement of the pronator teres,
flexor carpi radialis, palmaris longus, and flexor carpi ulnaris,
respectively.
Anatomic snuffbox
The intermediate layer in the anterior compartment of the Thumb
forearm contains a single muscle (see figure 12.11b), the flexor Abductor pollicis longus tendon
digitorum superficialis. This muscle splits into four tendons that Extensor pollicis brevis tendon
each insert on the middle phalanges of fingers 2–5. This muscle
Location of the “anatomic snuffbox.”
crosses over the wrist, MP joints, and PIP (proximal interphalan-
geal) joints of fingers 2–5; thus, it flexes all of these joints. Since
the flexor digitorum superficialis does not cross over the DIP
(distal interphalangeal) joints of these fingers, it cannot move the
DIP joints.
The deep layer of the forearm anterior compartment muscles humerus (figure 12.13a). These muscles are positioned laterally
includes the flexor pollicis longus (lateral side) and the flexor digi- to medially as follows:
torum profundus (medial side). Deep to both of these muscles is
■ The extensor carpi radialis longus is a long, tapered
the pronator quadratus muscle, discussed previously with muscles
muscle that is medial to the brachioradialis. It extends the
that pronate the forearm (see figure 12.11c).
wrist and abducts the hand at the wrist.
The flexor pollicis longus attaches to the distal phalanx of
■ The extensor carpi radialis brevis works synergistically
the thumb and flexes the MP and IP joints of the thumb. In addi-
with the extensor carpi radialis longus.
tion, because this muscle crosses the wrist joint, it can weakly flex
■ The extensor digitorum splits into four tendons that insert
the wrist. The flexor digitorum profundus lies deep to the flexor
on the distal phalanges of fingers 2–5. It extends the wrist,
digitorum superficialis. This muscle splits into four tendons that
MP joints, PIP joints, and DIP joints of fingers 2–5.
insert on the distal phalanges of fingers 2–5. At the level of the
■ The extensor digiti minimi attaches to the distal phalanx
middle phalanges, the tendons of the flexor digitorum superficialis
of finger 5. It works with the extensor digitorum to extend
split to allow the flexor digitorum profundus tendons to pass to the
the little finger.
tips of the fingers. The flexor digitorum profundus flexes the wrist,
■ On the medial surface of the posterior forearm, the
MP joints, PIP joints, and DIP joints of fingers 2–5.
extensor carpi ulnaris inserts on the fifth metacarpal bone,
Muscles of the posterior compartment of the forearm are
where it acts to extend the wrist and adduct the hand.
primarily wrist and finger extensors. An exception is the supina-
tor, which helps supinate the forearm. The posterior compart- The deep layer originates directly on the posterior forearm
ment muscles may be subdivided into a superficial layer and a bones and inserts on the wrist or hand bones (figure 12.13b). These
deep layer. muscles are arranged from lateral to medial in the following order:
The superficial layer of posterior forearm muscles originates supinator (previously described), abductor pollicis longus, exten-
from a common extensor tendon on the lateral epicondyle of the sor pollicis brevis, extensor pollicis longus, and extensor indicis.
mck78097_ch12_354-396.indd 371 2/14/11 3:25 PM

Brachioradialis
Extensor carpi Anconeus

radialis longus
Brachioradialis
Extensor carpi Extensor carpi
Anconeus radialis brevis radialis longus
Flexor carpi ulnaris Extensor carpi

Extensor digitorum radialis brevis
Extensor carpi ulnaris Extensor digitorum
Extensor digiti minimi Extensor carpi ulnaris

Extensor pollicis brevis
Extensor digiti minimi
Extensor pollicis brevis
Extensor retinaculum
Extensor digitorum tendons
Extensor digitorum tendons
(a) Right posterior forearm, superficial views
Olecranon process of ulna
Supinator
Figure 12.13
Posterior Forearm Muscles. The posterior forearm muscles
Extensor pollicis longus supinate the forearm or extend the wrist or fingers. They may be
subdivided into (a) superficial and (b) deep groups, as shown in
Extensor indicis Extensor pollicis brevis
these views of the right forearm.
Dorsal interossei
(b) Right posterior forearm, deep views
mck78097_ch12_354-396.indd 372 2/14/11 3:25 PM

Table 12.6 Forearm Muscles That Move the Wrist Joint, Hand, and Fingers
ANTERIOR MUSCLES: SUPERFICIAL
Pronator teres (described in
table 12.4)
Flexor carpi radialis (flek ́ser kar ́pı̄ Flexes wrist and abducts hand O: Medial epicondyle of humerus Median nerve (C6–C7 fibers)
rā-dē-āl ́is) I: Base of metacarpals II and III
carpi = wrist
Palmaris longus (pawl-mar ́is Weak wrist flexor O: Medial epicondyle of humerus Median nerve (C6–C7 fibers)
lon ́gŭs) I: Flexor retinaculum and palmar
aponeurosis
Flexor carpi ulnaris (ŭl-nar ́is) Flexes wrist and adducts hand O: Medial epicondyle of humerus; Ulnar nerve (C8–T1)
olecranon and posterior surface
of ulna
I: Pisiform and hamate bones; base
of metacarpal V
ANTERIOR MUSCLES: INTERMEDIATE
Flexor digitorum superficialis (dij ́i- Flexes wrist, 2nd–5th MP joints, and O: Medial epicondyle of humerus, Median nerve (C6–C7 fibers)
tōr ́ŭm soo ́per-fish-ē-ā ́lis) PIP joints coronoid process of ulna
superficial = close to surface I: Middle phalanges of fingers 2–5
ANTERIOR MUSCLES: DEEP
Flexor pollicis longus (pol ́i-sis Flexes MP joint of thumb, IP joint of O: Anterior shaft of radius; Median nerve (C6–C7 fibers)
lon ́gŭs) thumb; weakly flexes wrist interosseous membrane
pollex = thumb I: Distal phalanx of thumb
Flexor digitorum profundus Flexes wrist, 2nd–5th MP joints, PIP O: Anteromedial surface of ulna; Lateral one-half of muscle innervated
(prō-fŭn ́dŭs) joints, and DIP joints interosseous membrane by median nerve (C6–C8 fibers),
profound = deep I: Distal phalanges of fingers 2–5 medial one-half of muscle innervated
by ulnar nerve (C8 fibers)
Pronator quadratus (described in
table 12.4)
POSTERIOR MUSCLES: SUPERFICIAL
Extensor carpi radialis longus Extends wrist, abducts hand O: Lateral supracondylar ridge of Radial nerve (C6–C7 fibers)
(eks-ten ́ser) humerus
I: Base of metacarpal II
Extensor carpi radialis brevis Extends wrist, abducts hand O: Lateral epicondyle of humerus Radial nerve (C6–C7 fibers)
(brev ́is) I: Base of metacarpal III
brevis = short
Extensor digitorum (dij ́i-tōr ́ūm) Extends wrist, extends 2nd–5th MP O: Lateral epicondyle of humerus Radial nerve (C6–C8 fibers)
joints, PIP joints, and DIP joints I: Distal and middle phalanges of
fingers 2–5
Extensor digiti minimi (dij ́i-tı̄ Extends wrist, MP, and PIP joints of O: Lateral epicondyle of humerus Radial nerve (C6–C8 fibers)
mi ́nı̄-mı̄) finger 5 I: Proximal phalanx of finger 5
digitus minimus = little finger
Extensor carpi ulnaris Extends wrist, adducts hand O: Lateral epicondyle of humerus; Radial nerve (C6–C8 fibers)
posterior border of ulna
I: Base of metacarpal V
(continued on next page)
These muscles weakly extend the wrist, and perform the following ■ The extensor pollicis longus extends the MP and IP joints
other functions: of the thumb.
■ The extensor indicis is the most medial muscle of the
■ The abductor pollicis longus inserts on the first
deep posterior compartment. It extends the MP, PIP,
metacarpal. It abducts the thumb.
and DIP joints of the index finger (finger 2).
■ The extensor pollicis brevis lies immediately medial to
the abductor pollicis longus. The extensor pollicis brevis
attaches to the proximal phalanx of the thumb and helps Table 12.6 summarizes the characteristics of the muscles
extend the MP joint of the thumb. that move the wrist joint, hand, and fingers.
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Table 12.6 Forearm Muscles That Move the Wrist Joint, Hand, and Fingers (continued)
POSTERIOR MUSCLES: DEEP
Abductor pollicis longus Abducts thumb, extends wrist O: Proximal dorsal surfaces of radius Radial nerve (C6–C8 fibers)
(ab-dūk ́ter, -tōr) (weakly) and ulna; interosseous membrane
I: Lateral edge of metacarpal I
Extensor pollicis brevis Extends MP joints of thumb, extends O: Posterior surface of radius; Radial nerve (C6–C8 fibers)
wrist (weakly) interosseous membrane
I: Proximal phalanx of thumb
Extensor pollicis longus Extends MP and IP joints of thumb, O: Posterior surface of ulna; Radial nerve (C6–C8 fibers)
extends wrist (weakly) interosseous membrane
I: Distal phalanx of thumb
Extensor indicis (in ́di-sis) Extends MP, PIP, and DIP joints of O: Posterior surface of ulna; Radial nerve (C6–C8 fibers)
index = forefinger finger 2, extends wrist (weakly) interosseous membrane
I: Tendon of extensor digitorum
Supinator (described in table 12.4)
MP = metacarpophalangeal, PIP = proximal interphalangeal, DIP = distal interphalangeal
12.1e Intrinsic Muscles of the Hand interossei are three small muscles that insert on fingers 2, 4, and
The intrinsic muscles of the hand are small muscles that both 5 and adduct the fingers. In addition, these muscles work with
originate and insert on the hand; they are housed entirely within the lumbricals and dorsal interossei to flex the MP joints and at
the palm (figure 12.14). These muscles are divided into three the same time extend the PIP and DIP joints of fingers 2–5. The
groups: (1) The thenar group forms the thick, fleshy mass (thenar adductor pollicis is sometimes incorrectly classified as a palmar
eminence) at the base of the thumb. (2) The hypothenar group interosseous muscle. As its name suggests, this muscle adducts
forms a smaller fleshy mass (hypothenar eminence) at the base the thumb.
of the little finger. (3) The midpalmar group occupies the space
between the first two groups.
The thenar and hypothenar groups contain smaller muscles: Study Tip!
■ Small flexors (flexor pollicis brevis in the thenar group and To remember the functions of the palmar and dorsal interosseous
flexor digiti minimi brevis in the hypothenar group) flex muscles, use this mnemonic:
the thumb and the little finger, respectively. PAD-DAB
■ Abductors (abductor pollicis brevis in the thenar group
and abductor digiti minimi in the hypothenar group) (Palmar interossei ADduct the fingers, while Dorsal interossei
abduct the thumb and little finger, respectively. ABduct the fingers.)
■ Opponens muscles (opponens pollicis in the thenar group
and opponens digiti minimi in the hypothenar group)
assist in the opposition of the thumb and little finger, The intrinsic muscles of the hand are summarized in
respectively. table 12.7 and a summary of muscle actions at the wrist and hand
The midpalmar group contains 12 muscles that are par- are listed in table 12.8.
titioned into the following subgroups: lumbricals, dorsal inter-
ossei, palmar interossei, and adductor pollicis. The lumbrical W H AT D I D Y O U L E A R N?
muscles are four worm-shaped muscles. These muscles flex the ●
5 Identify the muscles that rotate (pronate or supinate) the forearm.
MP joints and at the same time extend the PIP and DIP joints of
fingers 2–5. The dorsal interossei are four deep bipennate mus- ●
6 What muscles are flexors of the forearm?
cles located between the metacarpals. They flex the MP joints ●
7 What are the actions of the extensor carpi radialis muscles?
and at the same time extend the PIP and DIP joints of fingers 2–5. ●
8 Identify the intrinsic muscles of the hand that cause abduction of
In addition, the dorsal interossei abduct fingers 2–5. The palmar the fingers.
mck78097_ch12_354-396.indd 374 2/14/11 3:25 PM

Tendon sheath
Flexor digitorum
profundus tendon
Flexor digitorum
profundus tendon
Flexor pollicis Flexor digitorum

longus tendon superficialis tendon
Flexor digitorum
superficialis tendon Flexor pollicis
longus tendon
First dorsal
interosseous Lumbricals
Lumbricals Adductor
pollicis
Flexor pollicis
Flexor digiti Flexor pollicis Opponens brevis
minimi brevis brevis
digiti minimi Abductor pollicis
Abductor digiti minimi Abductor pollicis Flexor digiti brevis
brevis minimi brevis
Abductor digiti
minimi
Flexor retinaculum
Palmaris longus
tendon (cut)
(a) Right hand, superficial palmar view
2nd dorsal
interosseous
Extensor 3rd dorsal
indicis tendon interosseous
Palmar interossei
First dorsal 4th dorsal
interosseous interosseous
Transverse Extensor pollicis Extensor digiti minimi
head longus tendon tendon
Adductor
Oblique Abductor digiti minimi
Opponens digiti minimi pollicis Extensor pollicis
head
Flexor brevis tendon
Opponens pollicis Extensor digitorum
retinaculum (cut) tendons
Carpal tunnel Flexor carpi
radialis tendon
Flexor carpi
ulnaris tendon Abductor pollicis
longus tendon
(b) Right hand, deep palmar view (c) Right hand, posterior view
Figure 12.14
Intrinsic Muscles of the Hand. These muscles allow the fine, controlled movements necessary for such activities as writing, typing, and playing
a guitar. (a) Palmar (anterior) views of the superficial muscles of the right hand. (b) Palmar view of the deep muscles. (c) Posterior (dorsal) view of
the superficial muscles.
mck78097_ch12_354-396.indd 375 2/14/11 3:25 PM

Table 12.7 Intrinsic Muscles of the Hand

THENAR GROUP
Flexor pollicis brevis Flexes thumb O: Flexor retinaculum, trapezium Median nerve (C8–T1 fibers)
I: Proximal phalanx of thumb
Abductor pollicis brevis Abducts thumb O: Flexor retinaculum, scaphoid, trapezium Median nerve (C8–T1 fibers)
I: Lateral side of proximal phalanx of thumb
Opponens pollicis (ō-pō ́nens) Opposition of thumb O: Flexor retinaculum, trapezium Median nerve (C8–T1 fibers)
opponens = to place against I: Lateral side of metacarpal I
HYPOTHENAR GROUP
Flexor digiti minimi brevis Flexes finger 5 O: Hamate bone, flexor retinaculum Ulnar nerve (C8–T1)
I: Proximal phalanx of finger 5
Abductor digiti minimi Abducts finger 5 O: Pisiform bone, tendon of flexor carpi ulnaris Ulnar nerve (C8–T1)
I: Proximal phalanx of finger 5
Opponens digiti minimi Opposition of finger 5 O: Hamate bone, flexor retinaculum Ulnar nerve (C8–T1)
I: Metacarpal bone V
MIDPALMAR GROUP
Lumbricals (lŭm ́bri-kălz) Flexes 2nd–5th MP joints and O: Tendons of flexor digitorum profundus Median nerve (lateral two
lumbricus = earthworm extends 2nd–5th PIP and DIP joints I: Dorsal tendons on fingers 2–5 lumbricals 1, 2) and ulnar nerve
(medial two lumbricals 3, 4)
Dorsal interossei (dōr ́săl Abducts fingers 2–5; flexes MP joints O: Adjacent, opposing faces of metacarpals Ulnar nerve (C8–T1)
in ́ter-os ́ē-ı̄) 2–5, and extends PIP and DIP joints I: Dorsal tendons on fingers 2–5
interossei = between bones
Palmar interossei (pal ́mer) Adducts fingers 2–5; flexes MP joints O: Metacarpal bones II, IV, V Ulnar nerve (C8–T1)
2–5, and extends PIP and DIP joints I: Sides of proximal phalanx bases for fingers
2, 4, and 5
Adductor pollicis Adducts thumb O: Oblique head: capitate bone, bases of Ulnar nerve (C8–T1)
metacarpals II, III
Transverse head: metacarpal III
I: Medial side of proximal phalanx of thumb
Table 12.8 Summary of Muscle Actions at the Wrist and Hand

Hand Abduction Hand Adduction Wrist Extension Wrist Flexion
Flexor carpi radialis Extensor carpi ulnaris Extensor digitorum Flexor carpi radialis
Extensor carpi radialis brevis Flexor carpi ulnaris Extensor carpi radialis brevis Flexor carpi ulnaris
Extensor carpi radialis longus Extensor carpi radialis longus Flexor digitorum superficialis
Extensor carpi ulnaris Flexor digitorum profundus
(Extensor indicis) (Palmaris longus)
(Extensor pollicis longus) (Flexor pollicis longus)
(Extensor pollicis brevis)
(Abductor pollicis longus)
Finger Abduction Finger Adduction IP Joint Extension IP Joint Flexion
Dorsal interossei Palmar interossei Extensor digitorum Flexor digitorum profundus
Abductor pollicis longus Adductor pollicis Extensor indicis Flexor digitorum superficialis
Abductor pollicis brevis Extensor pollicis brevis Flexor pollicis longus
Abductor digiti minimi Extensor pollicis longus Flexor pollicis brevis
Extensor digiti minimi Flexor digiti minimi
Lumbricals
Dorsal interossei
Palmar interossei
Parentheses indicate only a slight effect.
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lata, the deep fascia of the thigh, encircles the thigh muscles like
12.2 Muscles That Move the Pelvic a supportive stocking and tightly binds them. The fascia lata parti-
tions the thigh muscles into compartments, each with its own blood
Girdle and Lower Limb and nerve supply. The anterior compartment muscles either extend
Learning Objectives: the knee or flex the thigh. The muscles of the medial compartment
act as adductors of the thigh. The muscle in the lateral compart-
1. Describe the major movements at the pelvic girdle and
ment abducts the thigh. Most muscles of the posterior compartment
lower limb, and identify the muscles involved.
act as both flexors of the knee and extensors of the thigh. Some of
2. Name the muscles that move the thigh, and explain how
these muscles also abduct the thigh. We discuss the muscles that
they are organized into movement groups.
move the thigh first.
3. Identify and locate the muscles that move the leg, ankle,
Most muscles that act on the thigh originate on the os coxae
foot, and toes.
and insert on the femur. These muscles stabilize the highly mobile
The most powerful and largest muscles in the body are those hip joint and support the body during standing and walking.
of the lower limb. Several of these muscles cross and act upon two Multiple muscles insert on the anterior femur and flex the
joints—the hip joint and the knee joint. thigh (figure 12.15a): The psoas major and the iliacus have dif-
ferent origins, but they share the common insertion on the lesser
12.2a Muscles That Move the Hip Joint/Thigh trochanter of the femur. Collectively, the two muscles merge and
Note that in the subsequent discussion the phrases “moving the insert on the femur as the iliopsoas. Together, these muscles
thigh” and “moving the hip joint” mean the same thing. The fascia work synergistically to flex the thigh. A long, thin muscle called
Figure 12.15
Muscles That Act on the Hip and Thigh. (a) Anterior, (b) lateral,
and (c) deep posterior views of the right thigh. Most muscles that act
on the thigh (femur) originate from the os coxae. (continued on next
page)
Psoas minor
Iliac crest
Psoas major
Iliacus
Gluteus medius
Tensor
fasciae latae
Sartorius
Gluteus maximus
Iliopsoas
Pectineus Rectus femoris
Adductor longus
Adductor brevis
Gracilis Vastus lateralis
Iliotibial tract
Adductor magnus Biceps femoris, long head
Semimembranosus
Biceps femoris, short head
Patella
Gastrocnemius
(a) Right thigh, anterior view (b) Right thigh, lateral view
mck78097_ch12_354-396.indd 377 2/14/11 3:25 PM

Iliac crest
Sacrum Gluteus medius (cut)
Gluteus maximus (cut)

Gluteus minimus
Gluteus medius (cut)

Piriformis
Gluteus maximus (cut)

Superior gemellus
Obturator internus
Sacrotuberous ligament
Inferior gemellus
Ischial tuberosity Quadratus femoris
Gracilis
Biceps femoris, long head
Adductor magnus
Figure 12.15 Semitendinosus Iliotibial tract

Muscles That Act on the Hip
and Thigh. (continued)
Iliac crest
Sacrum
Gluteus medius
(cut)
Superior gluteal
vessels
Gluteus maximus
(cut) Gluteus minimus
Piriformis
Gluteus medius
Superior gemellus (cut)
Obturator internus
Inferior gemellus
Sacrotuberous ligament Quadratus femoris
Ischial tuberosity
Biceps femoris,
long head
Sciatic nerve (cut)
Semitendinosus
(c) Right thigh, deep posterior view
the sartorius crosses over the anterior thigh and helps flex the The obturator externus does not adduct the thigh, but it laterally
thigh. The rectus femoris also flexes the thigh and is examined rotates the thigh.
later in this chapter in connection with the thigh muscles that On the lateral thigh is a single muscle called the tensor
move the knee joint and leg. fasciae latae (figure 12.15b). It attaches to a lateral thickening of
Six muscles are located in the medial compartment of the the fascia lata, called the iliotibial tract (or iliotibial band), which
thigh. Most of these muscles adduct the thigh, and some of them extends from the iliac crest to the lateral condyle of the tibia. The
perform additional functions. The adductor longus, adductor tensor fasciae latae abducts and medially rotates the thigh.
brevis, gracilis, and pectineus also flex the thigh. A fifth muscle, The posterior muscles that move the thigh include three glu-
the adductor magnus, also extends and laterally rotates the thigh. teal muscles and the “hamstring” muscle group (figure 12.15b, c).
mck78097_ch12_354-396.indd 378 2/14/11 3:25 PM

The gluteus maximus is the largest of the three gluteal muscles and semitendinosus. These muscles share a common origin on
and one of the largest muscles in the body. It is the chief extensor the ischial tuberosity of the os coxae, and insert on the leg.
of the thigh, and it laterally rotates the thigh. Deep to the gluteus Thus, these muscles move both the thigh and the knee. Their
maximus is the gluteus medius, a powerful abductor of the thigh. primary thigh movement is extension. These muscles will be
This muscle also medially rotates the thigh. Intramuscular injec- discussed again when we discuss movement at the knee joint
tions are often given in this muscle. The smallest of the gluteal and leg.
muscles is the gluteus minimus. It lies deep to the gluteus medius, Table 12.9 summarizes the characteristics of the muscles
with which it works to abduct and medially rotate the thigh. that move the hip joint and thigh, and table 12.10 groups these
Deep to the gluteal muscles are a group of muscles that later- muscles according to their common actions on the hip joint
ally rotate the thigh and the hip joint, as when the legs are crossed and thigh.
with one ankle resting on the knee. These muscles are organized
from superior to inferior within the posterior thigh as the pirifor-
W H AT D I D Y O U L E A R N?
mis, superior gemellus, obturator internus, inferior gemellus,
and quadratus femoris. ●9 What two muscles insert on the iliotibial tract?
Finally, the posterior thigh contains a group of muscles
that are collectively referred to as the hamstrings because a
●
10 What muscles adduct the thigh?
ham is strung up by these muscles while being smoked. The ●

11 Which muscles laterally rotate the thigh?
hamstring muscles are the biceps femoris, semimembranosus, ●
12 Identify the muscles that extend the thigh.
Table 12.9 Muscles That Move the Hip Joint/Thigh

ANTERIOR THIGH COMPARTMENT (THIGH FLEXORS)
Psoas major (sō ́as mā ́jŏr) Flexes thigh O: Transverse processes and bodies Branches of lumbar plexus (L2–L3)
psoa = loin muscle of T12–L5 vertebrae
I: Lesser trochanter of femur with
iliacus
Iliacus (il-ı̄ ́ă-kŭs) Flexes thigh O: Iliac fossa Femoral nerve (L2–L3 fibers)
iliac = ilium I: Lesser trochanter of femur with
psoas major
Sartorius (sar-tōr ́ē-ŭs) Flexes thigh and rotates thigh O: Anterior superior iliac spine Femoral nerve (L2–L3 fibers)
sartor = tailor laterally; flexes leg and rotates leg I: Tibial tuberosity, medial side
medially
Rectus femoris (rek ́tūs fem ́ō-ris) Flexes thigh, extends leg O: Anterior inferior iliac spine Femoral nerve (L2–L4)
rectus = straight I: Quadriceps tendon to patella and
femoris = femur then patellar ligament to tibial
tuberosity
MEDIAL THIGH COMPARTMENT (THIGH ADDUCTORS)
Adductor longus (a-dŭk ́ter, -tōr) Adducts thigh; flexes thigh O: Pubis near pubic symphysis Obturator nerve (L2–L4)
adduct = to move toward midline I: Linea aspera of femur
Adductor brevis Adducts thigh; flexes thigh O: Inferior ramus and body of pubis Obturator nerve (L2–L3 fibers)
I: Upper third of linea aspera of
femur
Gracilis (gră-cil ́is) Adducts and flexes thigh; flexes leg O: Inferior ramus and body of pubis Obturator nerve (L2–L4)
gracilis = slender I: Upper medial surface of tibia
Pectineus (pek-ti ́nē-us) Adducts thigh; flexes thigh O: Pectineal line of pubis Femoral nerve (L2–L4) or obturator
pectin = comb I: Pectineal line of femur nerve (L2–L4)
Adductor magnus (mag ́nŭs) Adducts thigh; adductor part of O: Inferior ramus of pubis and Adductor part: Obturator nerve
magnus = large muscle flexes thigh; hamstring part ischial tuberosity (L2–L4)
of muscle extends and laterally I: Hamstring part: Linea aspera of Hamstring part: Tibial division of
rotates thigh femur sciatic nerve (L2–L4 fibers)
Adductor part: Adductor tubercle
of femur
Obturator externus (ob ́too-rā-tŏr Laterally rotates thigh O: Margins of obturator foramen and Obturator nerve (L3–L4 fibers)
eks-ter ́nŭs) obturator membrane
obturator = any structure that I: Trochanteric fossa of posterior
occludes an opening femur
externus = outside
(continued on next page)
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Table 12.9 Muscles That Move the Hip Joint/Thigh (continued)

LATERAL THIGH COMPARTMENT (THIGH ABDUCTOR)
Tensor fasciae latae (ten ́sōr fash ́ă Abducts thigh; medially rotates thigh O: Iliac crest and lateral surface of Superior gluteal nerve (L4–S1)
lā ́tē) anterior superior iliac spine
tensor = to make tense I: Iliotibial band
fascia = band
lata = wide
GLUTEAL GROUP
Gluteus maximus (gloo-tē ́ŭs Extends thigh; laterally rotates thigh O: Iliac crest, sacrum, coccyx Inferior gluteal nerve (L5–S2)
mak ́si-mŭs) I: Iliotibial tract of fascia lata; linea
glutos = buttock aspera and gluteal tuberosity of
maximus = largest femur
Gluteus medius (mē ́dē-ŭs) Abducts thigh; medially rotates thigh O: Posterior iliac crest; lateral Superior gluteal nerve (L4–S1)
medius = middle surface between posterior and
anterior gluteal lines
I: Greater trochanter of femur
Gluteus minimus (min ́i-mŭs) Abducts thigh; medially rotates thigh O: Lateral surface of ilium between Superior gluteal nerve (L4–S1)
minimus = smallest inferior and anterior gluteal lines
I: Greater trochanter of femur
DEEP MUSCLES OF THE GLUTEAL REGION (LATERAL THIGH ROTATORS)
Piriformis (pir ́i-fōr ́mis) Laterally rotates thigh O: Anterolateral surface of sacrum Nerve to piriformis (S1–S2)
pirum = pear I: Greater trochanter
forma = form
Superior gemellus (jē-mel ́ŭs) Laterally rotates thigh O: Ischial spine and tuberosity Nerve to obturator internus (L5–S1)
gemin = twin, double I: Obturator internus tendon
Obturator internus (in-ter ́nŭs) Laterally rotates thigh O: Posterior surface of obturator Nerve to obturator internus (L5–S1)
internus = inside membrane; margins of obturator
foramen
I: Greater trochanter
Inferior gemellus Laterally rotates thigh O: Ischial tuberosity Nerve to quadratus femoris (L5–S1)
I: Obturator internus tendon
Quadratus femoris Laterally rotates thigh O: Lateral border of ischial Nerve to quadratus femoris (L5–S1)
tuberosity
I: Intertrochanteric crest of femur
POSTERIOR THIGH (HAMSTRING) COMPARTMENT (THIGH EXTENSORS AND LEG FLEXORS)
Biceps femoris Extends thigh (long head only); O: Long head: Ischial tuberosity Long head: Tibial division of sciatic
Long head flexes leg (both long head and short Short head: Linea aspera of femur nerve (L4–S1 fibers)
head); laterally rotates leg I: Head of fibula Short head: Common fibular division
Short head
of sciatic nerve (L5–S1 fibers)
Semimembranosus (sem ́ē-mem- Extends thigh and flexes leg; O: Ischial tuberosity Tibial division of sciatic nerve
bră-nō ́sŭs) medially rotates leg I: Posterior surface of medial (L4–S1 fibers)
semi = half condyle of tibia
membranosus = membrane
Semitendinosus (sem ́ē-ten-di- Extends thigh and flexes leg; O: Ischial tuberosity Tibial division of sciatic nerve
nō ́sŭs) medially rotates leg I: Proximal medial surface of tibia (L4–S1 fibers)
tendinosus = tendon
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Table 12.10 Summary of Muscle Actions at the Hip Joint/Thigh

Abduction Adduction Extension Flexion Lateral Rotation Medial Rotation
Gluteus medius Adductor brevis, Gluteus maximus Iliopsoas Adductor magnus Gluteus medius
longus, magnus (hamstring part)
Gluteus minimus Gracilis Adductor magnus Adductor brevis, Gluteus maximus Gluteus minimus
(hamstring part) longus, magnus
(adductor part)
Tensor fasciae latae Pectineus Biceps femoris (long Pectineus Sartorius Tensor fasciae latae
head)
Semimembranosus Sartorius Obturator externus
Semitendinosus Rectus femoris Obturator internus
Gracilis Piriformis
Superior gemellus
Inferior gemellus
Quadratus femoris
Boldface indicates a prime mover; others are synergists.
12.2b Thigh Muscles That Move the Knee Joint/Leg extension and the most powerful muscle in the body. The quadri-
ceps femoris is a composite muscle with four heads, as shown on
The muscles that act on the knee form most of the mass of the
figure 12.17:
thigh. Muscles in the thigh are separated by deep fascia into ante-
rior, medial, and posterior compartments (figure 12.16). ■ The rectus femoris is on the anterior surface of the thigh;
The anterior (extensor) compartment of the thigh is com- this muscle originates on the os coxae, and so it also flexes
posed of the large quadriceps femoris, the prime mover of knee the thigh.
Figure 12.16
Actions of Muscles of the Thigh. A cross-sectional
view of the right thigh shows the muscles of the anterior,
medial, and posterior compartments. Some muscles
cannot be seen at the level of this cross section.
View of
cross
section Anterior
Vastus lateralis Medial

Anterior compartment of thigh
compartment of thigh Rectus femoris
Vastus medialis
Sartorius
Vastus intermedius
Femur
Lateral Medial
Adductor longus
Iliotibial tract
Adductor brevis
Gracilis
Posterior Biceps femoris,
short head Adductor magnus
compartment of thigh
Biceps femoris,
long head
Semitendinosus
Semimembranosus
Posterior
mck78097_ch12_354-396.indd 381 2/14/11 3:25 PM

Figure 12.17
Muscles of the Anterior Thigh. Muscles of the anterior thigh flex
the thigh and extend the leg. (a) Illustration and cadaver photo show
an anterior view of the right thigh. (b) Individual muscles of the right
anterior thigh.
Iliacus
Iliopsoas
Psoas major
Iliopsoas
Tensor Tensor
fasciae latae fasciae latae
Pectineus
Pectineus
Adductor longus
Adductor longus
Iliotibial tract Gracilis Iliotibial tract

Gracilis
Sartorius
Rectus femoris Sartorius
Rectus femoris
Vastus lateralis Vastus lateralis
Vastus medialis
Quadriceps Vastus medialis

tendon Quadriceps
Patella tendon
Patella
Patellar ligament
(a) Right thigh, anterior view
Greater trochanter
Rectus femoris Vastus intermedius
Sartorius
Vastus lateralis Vastus medialis
Patella
Patellar ligament
Tibia
(b) Anterior thigh muscles
mck78097_ch12_354-396.indd 382 2/14/11 3:26 PM

hamstring muscles in flexing the leg. The semimembranosus is

Study Tip! deep to the semitendinosus. It originates from the ischial tuberosity
and attaches to the medial side of the leg. The semitendinosus is
In general, muscles in the same compartment tend to perform
superficial to the semimembranosus and is attached to the medial
similar functions. So the muscles in the anterior compartment of the
leg. The semimembranosus and semitendinosus also medially
thigh tend to flex the thigh and extend the leg, the muscles in the
rotate the leg when the leg is flexed.
medial compartment tend to adduct the thigh, and the muscles in
Finally, several leg muscles span the knee joint and work
the posterior compartment tend to extend the thigh and flex the leg.
to flex the leg. These muscles (gastrocnemius, plantaris, and pop-
(Note: There are exceptions to these rules, but this generalization will
liteus) are discussed in the next section, as we examine muscles
help as you start learning muscle functions.)
of the leg.
Table 12.11 summarizes the characteristics of the muscles
that move the knee joint and leg.
■ The vastus lateralis forms the anterolateral surface of the W H AT D O Y O U T H I N K ?

thigh.
■ The vastus medialis forms the anteromedial surface of the ●
3 Recall that if a muscle spans a joint, it must move the joint (and
conversely, if a muscle doesn’t span a joint, it cannot move that
thigh. joint). Based on this rule, would you expect the iliopsoas to flex
■ The vastus intermedius is positioned deep to the rectus the knee joint/leg? Why or why not?
femoris and sandwiched between the other two vastus
muscles.
All four muscles converge on a single quadriceps tendon,
which extends to the patella and then continues inferiorly as the
patellar ligament and inserts on the tibial tuberosity. The patella
CLINICAL VIEW
becomes encased in this tendon and ligament. The quadriceps
femoris is the great extensor muscle of the leg. It extends the knee Lower Limb Muscle Injuries
when you stand up, take a step, or kick a ball, and it is very impor-
The muscle groups in the lower limbs are prone to injury, especially
tant in running, because it acts with the iliopsoas to flex the hip
in people who are physically active. Two examples of such injuries
while the leg is off the ground.
are groin pull and strained (or pulled) hamstrings.
The anterior compartment of the thigh contains another
muscle worth noting. The long, straplike sartorius projects A groin pull is caused by tearing, stretching, or straining the
obliquely across the anterior surface of the thigh from the supero- proximal attachments of the medial muscles of the thigh—the
lateral to the inferomedial side. It acts on both the hip and knee adductor muscles of the leg and/or the iliopsoas muscle. This
joints, flexing and laterally rotating the thigh while flexing and type of injury most frequently results from activities that involve
medially rotating the leg. This muscle is the longest in the body rapid accelerations, as are called for in football, baseball, tennis,
and is nicknamed the “tailor’s muscle” because it helps us sit running, and soccer.
cross-legged, as tailors used to do.
Strained or pulled hamstrings are common in athletes who
The medial (adductor) compartment of the thigh is named
perform quick starts and stops, run very fast, or sustain sudden
for the muscles that adduct the thigh (see figures 12.15a and
lateral or medial stress to the knee joint. The violent muscular
12.17a). The gracilis is part of this compartment and also flexes
exertion required to perform these running feats sometimes
the leg, since it spans the knee joint.
causes the tendinous origins of the hamstrings to be avulsed (torn
The posterior (flexor) compartment of the thigh con-
away) from their attachment on the ischial tuberosity. The biceps
tains the three hamstring muscles discussed previously (figure
femoris is especially susceptible to this type of stress injury.
12.18). These muscles also flex the leg. The biceps femoris is a
Contusions (bruising), blood vessel rupture, pain, hematoma
two-headed muscle that inserts on the lateral side of the leg. This
formation (accumulation of blood in soft tissue), and tearing of
muscle also can laterally rotate the leg when the leg is flexed. The
muscle fibers may accompany hamstring damage. To prevent this
long head of the biceps femoris originates on the ischial tuberosity
type of injury, experts recommend that athletes “warm up” and
with the semimembranosus and semitendinosus. The short head
perform stretching exercises prior to running.
of the biceps femoris originates on the linea aspera of the femur.
The short head cannot move the thigh, but it does help the other
mck78097_ch12_354-396.indd 383 2/14/11 3:26 PM

Iliac crest
Gluteus medius
Gluteus maximus
Adductor magnus
Gracilis
Iliotibial tract
Hamstrings
Semimembranosus
Semitendinosus
Biceps femoris,
long head
Figure 12.18 Biceps femoris,

short head
Muscles of the Gluteal
Region and Posterior
Thigh. Muscles of the
posterior thigh extend the
thigh and flex the leg.
(a) Illustration and cadaver
photo show the gluteal and
posterior muscles of the
right thigh. (b) Individual
muscles that extend the
thigh are shown in bold.
Note that the short head (a) Right thigh, posterior view
of biceps femoris does
not participate in thigh
extension.
Ischial tuberosity
Linea aspera
Semitendinosus Adductor
Semimembranosus magnus
Biceps femoris,
long head
Biceps femoris,
short head
Head of fibula
(b) Thigh extensors
mck78097_ch12_354-396.indd 384 2/14/11 3:26 PM

Table 12.11 Thigh Muscles That Move the Knee Joint/Leg

LEG EXTENSORS (ANTERIOR THIGH MUSCLES)
Quadriceps Femoris
Rectus femoris Extends leg; flexes thigh O: Anterior inferior iliac spine Femoral nerve (L2–L4)
I: Quadriceps tendon to patella and
then patellar ligament to tibial
tuberosity
Vastus intermedius (vas ́tūs in- Extends leg O: Anterolateral surface of femur Femoral nerve (L2–L4)
ter-mē ́dē-ŭs) I: Quadriceps tendon to patella and
vastus = great then patellar ligament to tibial
intermedius = intermediate tuberosity
Vastus lateralis (lat-er-ăl ́is) Extends leg O: Greater trochanter and linea Femoral nerve (L2–L4)
aspera
tuberosity
Vastus medialis (mē-dē-ăl ́is) Extends leg O: Intertrochanteric line and linea Femoral nerve (L2–L4)
aspera of femur
tuberosity
LEG FLEXORS
Sartorius Flexes thigh and rotates thigh See table 12.9
laterally; flexes leg and rotates leg
medially
Gracilis Flexes and adducts thigh; flexes leg See table 12.9
Hamstrings (biceps femoris, Extend thigh and flex leg; rotate leg See table 12.9
semimembranosus, laterally
semitendinosus)
dorsiflexes and weakly everts the foot. The tibialis anterior is

12.2c Leg Muscles the primary dorsiflexor of the foot at the ankle. This muscle
The muscles that move the ankle, foot, and toes are housed within attaches to the medial plantar side of the foot, so it also inverts
the leg and are called the crural muscles. Some of these muscles the foot. Analogous to the wrist, tendons of the muscles within
also help flex the leg. The deep fascia partitions the leg muscula- the anterior compartment are held tightly against the ankle by
ture into three compartments (anterior, lateral, and posterior), each multiple deep fascia thickenings, collectively referred to as the
with its own nerve and blood supply (figure 12.19). extensor retinaculum.
Anterior compartment leg muscles dorsiflex the foot The lateral compartment leg muscles contain two synergis-
and/or extend the toes (figure 12.20). The extensor digito- tic muscles that are very powerful evertors of the foot and weak
rum longus sends four long tendons to attach to the dorsal sur- plantar flexors (figure 12.21). The long, flat fibularis longus
face of toes 2–5. This muscle dorsiflexes the foot and extends (or peroneus longus) is a superficial lateral muscle that covers
toes 2–5. The extensor hallucis longus sends a tendon to the the fibula. Its tendon attaches to the plantar side of the foot on
dorsum of the great toe (hallux), and so it dorsiflexes the foot the base of metatarsal I and the medial cuneiform. The fibularis
and extends the great toe. The fibularis tertius (or peroneus brevis (or peroneus brevis) lies deep to the fibularis longus. Its
tertius) extends from the extensor digitorum longus muscle. It tendon inserts onto the base of the fifth metatarsal.
mck78097_ch12_354-396.indd 385 2/14/11 3:26 PM

Anterior
Tibialis anterior Tibia
View of
cross Extensor digitorum
section longus
Extensor hallucis
Anterior Posterior
longus
compartment of leg compartment of leg
Fibula
Tibialis posterior
Fibularis longus
Flexor digitorum longus
Fibularis brevis Flexor hallucis longus
Lateral Medial
Soleus
Plantaris tendon
Gastrocnemius
(medial head)
Lateral
compartment of leg Gastrocnemius
(lateral head)
Posterior
Figure 12.19
Actions of Muscles of the Leg. A cross-sectional view of the right leg shows the muscles of the anterior, lateral, and posterior compartments,
which perform different movements.
The posterior compartment of the leg is composed of common tendon of insertion, the calcaneal tendon (or Achilles
seven muscles that are separated into superficial and deep groups tendon).
(figure 12.22). The superficial muscles and most of the deep The deep layer of the posterior compartment contains four
muscles plantar flex the foot at the ankle. The superficial layer muscles. The flexor digitorum longus attaches to the distal pha-
of the posterior compartment contains three muscles: gastroc- langes of toes 2–5, plantar flexes the foot, and flexes the MP, PIP,
nemius, soleus, and plantaris. The gastrocnemius is the most and DIP joints of toes 2–5. The flexor hallucis longus originates
superficial muscle. It has two thick muscle bellies, the lateral on the fibula, and yet its tendon travels medially and runs along
head and the medial head, that collectively form the prominence the plantar side of the foot to attach to the distal phalanx of the
on the posterior part of the leg often referred to as the “calf.” great toe. This muscle plantar flexes the foot and flexes the great
This muscle spans both the knee and the ankle joints; it flexes toe. The tibialis posterior is the deepest of the posterior compart-
the leg and plantar flexes the foot. The soleus is a broad, flat ment muscles. It plantar flexes and inverts the foot. The popliteus
muscle deep to the gastrocnemius that resembles a flat fish. This forms the floor of the popliteal fossa, and acts to flex the leg. This
muscle plantar flexes the foot. The plantaris is a small muscle muscle also medially rotates the tibia slightly to “unlock” the fully
that is absent in some individuals. It projects obliquely between extended knee joint. This muscle originates and inserts in the pop-
the gastrocnemius and soleus muscles. This muscle is a weak leg liteal region, so it only moves the knee, not the foot.
flexor and plantar flexor of the foot. Table 12.12 lists the characteristics of the muscles in the
The gastrocnemius and soleus are collectively known as leg. Table 12.13 groups muscles according to their action on the
the triceps surae, and together they are the most powerful plan- leg. Note that many thigh and leg muscles are involved with leg
tar flexors of all of the leg muscles. These two muscles share a flexion.
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Fibularis longus Gastrocnemius

Tibia
Fibularis longus
Gastrocnemius
Tibialis anterior
Tibia
Tibialis anterior
Fibularis brevis
Extensor digitorum longus Extensor digitorum longus
Extensor hallucis longus
Extensor hallucis longus Extensor retinaculum

Extensor hallucis brevis

Extensor hallucis Extensor digitorum brevis Extensor hallucis
longus tendon longus tendon
Fibularis tertius tendon Extensor digitorum
Extensor digitorum
longus tendons longus tendons
Extensor digitorum
brevis Extensor hallucis brevis
(a) Right leg, anterior view
Figure 12.20
Muscles of the Anterior Leg. The anterior muscles of the leg
Tibialis
anterior dorsiflex the foot and extend the toes. (a) Illustration and cadaver
Extensor photo show an anterior view of the right leg. (b) Individual muscles
digitorum
of the right anterior leg.
longus
Extensor
Fibularis hallucis
tertius longus
Fibularis
tertius
tendon
(b) Anterior leg muscles
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Patella Patella
Head of fibula
Head of fibula
Gastrocnemius
Tibialis anterior Tibialis anterior
Gastrocnemius
Soleus Soleus
Fibularis longus Fibularis longus
Extensor digitorum
longus Extensor digitorum
longus
Fibularis brevis Extensor hallucis longus Extensor hallucis

Fibularis brevis longus
Fibularis tertius Extensor hallucis Fibularis tertius
brevis
Calcaneal tendon Extensor hallucis
Extensor hallucis
longus tendon Extensor digitorum brevis
Extensor digitorum
brevis Extensor digitorum brevis
Extensor hallucis
longus tendons longus tendon
Fibular retinaculum
Extensor digitorum
Fibularis tertius
longus tendons
tendon Fibularis tertius tendon
5th metatarsal
5th metatarsal
(a) Right leg, lateral view
Figure 12.21
Muscles of the Lateral Leg. (a) Illustration and cadaver photo
show a lateral view of the right leg. (b) The fibularis longus and the
fibularis brevis evert and plantar flex the foot.
Fibularis longus
Fibularis brevis
Fibularis longus tendon

5th metatarsal
(b) Lateral leg muscles
mck78097_ch12_354-396.indd 388 2/14/11 3:26 PM

Plantaris
Plantaris (cut)
Gastrocnemius
(cut)
Popliteus
Gastrocnemius
Tibialis posterior
Lateral head
Medial head
Fibularis longus
Flexor digitorum
longus
Soleus
Flexor hallucis
Flexor hallucis longus
longus tendon
Calcaneal tendon
Fibularis brevis
Flexor retinaculum Fibular retinaculum
Medial malleolus
Lateral malleolus
Calcaneal tendon
(cut)
Calcaneus
(a) Right leg, superficial posterior view (b) Deep posterior view
Tibia Popliteus Figure 12.22

Muscles of the Posterior Leg. The posterior muscles of the leg
Fibula plantar flex the foot and flex the toes. (a) Superficial and (b) deep
Tibialis
posterior views of the posterior right leg. (c) Selected individual muscles of the
Flexor digitorum deep posterior compartment.
longus
Flexor
Interosseous hallucis
membrane longus
Tarsal and
metatarsal
bones Distal
phalanges of Distal
toes 2–5 phalanx
of hallux
(c) Deep posterior leg muscles
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Table 12.12 Leg Muscles

ANTERIOR COMPARTMENT (DORSIFLEXORS AND TOE EXTENSORS)
Extensor digitorum longus Extends toes 2–5; dorsiflexes foot O: Lateral condyle of tibia; anterior Deep fibular nerve (L4–S1)
surface of fibula; interosseous
membrane
I: Distal phalanges of toes 2–5
Extensor hallucis longus (hal ́ū-sis) Extends great toe (1); dorsiflexes foot O: Anterior surface of fibula; Deep fibular nerve (L4–S1)
hallux = great toe interosseous membrane
I: Distal phalanx of great toe (1)
Fibularis tertius (fib-ū-lar ́is Dorsiflexes and weakly everts foot O: Anterior distal surface of fibula; Deep fibular nerve (L5–S1)
ter ́shē-ŭs) interosseous membrane
fibularis = fibula I: Base of metatarsal V
tertius = third
Tibialis anterior (tib-ē-a ́lis) Dorsiflexes foot; inverts foot O: Lateral condyle and proximal Deep fibular nerve (L4–S1)
shaft of tibia; interosseous
membrane
I: Metatarsal I and first (medial)
cuneiform
LATERAL COMPARTMENT (EVERTORS AND WEAK PLANTAR FLEXORS)
Fibularis longus Everts foot; weak plantar flexor O: Head and superior two-thirds of shaft Superficial fibular nerve (L5–S2)
of fibula; lateral condyle of tibia
I: Base of metatarsal I; medial
cuneiform bone
Fibularis brevis Everts foot; weak plantar flexor O: Midlateral shaft of fibula Superficial fibular nerve (L5–S2)
I: Base of metatarsal V
POSTERIOR COMPARTMENT (PLANTAR FLEXORS, FLEXORS OF THE LEG AND TOES)
Superficial Layer
Triceps surae
Gastrocnemius (gas-trok-nē ́mē-ŭs) Flexes leg; plantar flexes foot O: Superior posterior surfaces of Tibial nerve (L4–S1 fibers)
gaster = belly lateral and medial condyles of
kneme = leg femur
I: Calcaneus (via calcaneal tendon)
Soleus (sō-lē ́ŭs) Plantar flexes foot O: Head and proximal shaft of Tibial nerve (L4–S1 fibers)
soleus = flat fish fibula; medial border of tibia
I: Calcaneus (via calcaneal tendon)
Plantaris (plan-tār ́is) Weak leg flexor and plantar flexor O: Lateral supracondylar ridge of Tibial nerve (L4–S1 fibers)
planta = sole of foot femur
I: Posterior region of calcaneus
Deep Layer
Flexor digitorum longus Plantar flexes foot; flexes MP, PIP, O: Posteromedial surface of tibia Tibial nerve (L5–S1 fibers)
and DIP joints of toes 2–5 I: Distal phalanges of toes 2–5
Flexor hallucis longus Plantar flexes foot; flexes MP and IP O: Posterior inferior two-thirds of Tibial nerve (L5–S1 fibers)
joints of great toe (1) fibula
I: Distal phalanx of great toe (1)
Tibialis posterior Plantar flexes foot; inverts foot O: Fibula, tibia, and interosseous Tibial nerve (L5–S1 fibers)
membrane
I: Metatarsals II–IV; navicular bone;
cuboid bone; all cuneiforms
Popliteus (pop-li-tē ́ŭs) Flexes leg; medially rotates tibia to O: Lateral condyle of femur Tibial nerve (L4–L5 fibers)
poplit = back of knee unlock the knee I: Posterior, proximal surface of
tibia
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Table 12.13 Summary of Muscle Actions at the

Knee Joint/Leg CLINICAL VIEW
Extension Flexion
Quadriceps femoris: Sartorius
Plantar Fasciitis
Rectus femoris Gracilis Plantar fasciitis (fas-ē-ı̄ ́t is) is an inflammation caused by chronic
irritation of the plantar aponeurosis (fascia). Most often, the
Vastus lateralis Adductor longus, brevis, magnus
inflammation is greatest at the origin of the plantar aponeurosis
Vastus intermedius Biceps femoris on the calcaneus bone. This condition is frequently caused by
Vastus medialis Semimembranosus overexertion that stresses the plantar fascia, but it may also be
related to age, since loss of elasticity in the aponeurosis, which
Semitendinosus
is known to occur with age, seems to be a factor in developing
Gastrocnemius this condition. Other factors associated with plantar fasciitis
Popliteus include weight-bearing activities (lifting heavy objects, jogging,
or walking), excessive body weight, improperly fitting shoes, and
(Plantaris)
poor biomechanics (wearing high-heeled shoes or having flat
Parentheses indicate only a slight effect. feet). Because plantar fasciitis can occur as a consequence of
repetitively pounding the feet on the ground, this condition has
become the most common cause of heel pain in runners.
12.2d Intrinsic Muscles of the Foot

The intrinsic muscles of the foot both originate and insert within
the foot. They support the arches and move the toes to aid locomo-
tion. Most of these muscles are comparable to the intrinsic muscles
of the hand, meaning that they have similar names and locations. joint of the great toe. The extensor digitorum brevis is deep to the
However, the intrinsic muscles of the foot rarely perform all the tendons of the extensor digitorum longus, and it extends the MP,
precise movements their names suggest. PIP, and DIP joints of toes 2–4.
The intrinsic foot muscles form a dorsal group and a plantar
group. The dorsal group contains only two muscles: the extensor W H AT D O Y O U T H I N K ?
hallucis brevis and the extensor digitorum brevis (see figures ●
4 The extensor digitorum brevis only goes to toes 2–4, so how is it
12.20 and 12.21). The extensor hallucis brevis extends the MP possible to extend your little toe (toe 5)?
CLINICAL VIEW: In Depth

Compartment Syndrome inflammation and swelling secondary to muscle strain, contusion, or
overuse. For example, compartment syndrome can occur in an individual
Cross sections of the limbs reveal that the musculature is surrounded who suddenly embarks on an intensive exercise regimen. More severe
by deep fascia. This deep fascia is tough and unyielding; it wraps compartment syndrome can occur due to trauma to the limb compart-
around the muscle like support hose, and it groups the muscles into ment, such as a bone fracture or rupture of a blood vessel.
compartments. Thus, the compartments of the leg (anterior, lateral,
The syndrome develops when the overworked muscles start to
and posterior) are subdivided by this fascia. Sometimes problems
swell, compressing other structures within the compartment. Since
develop within these compartments.
the connective tissue sheets forming the compartment boundaries are
Shin splints, also called shin splint syndrome, refers specifically to tight and cannot stretch, any accumulating fluid or blood increases
soreness or pain somewhere along the length of the tibia, usually on pressure on the muscles, nerves, and blood vessels. Both the circulatory
the inferior portion. Causes of the syndrome include one or more of supply and the nerves of the compartment become compressed and
the following: (1) stress fractures of the tibia; (2) tendonitis involv- compromised. The reduced blood flow (known as ischemia [is-kē ́mē-ă;
ing muscles of the anterior compartment muscles of the leg, often isch = to keep back, haima = blood]) leads to hypoxia (hı̄-pok ́sē -ă;
the tibialis anterior muscle; and (3) inflammation of the periosteum, hypo = under, oxo = oxygen), which is a lack of oxygen within the com-
called periostitis. Shin splints often occurs in runners or joggers who partment. If the blood flow is not restored, this situation can lead to
are either new to the sport or poorly conditioned. Athletes who run on death of nerves within 2 hours and death of skeletal muscle within
exceptionally hard surfaces (concrete, asphalt) or wear running shoes 6 hours. Although the damaged nerves may regenerate after the compart-
that do not properly support the foot are susceptible to shin splints. ment syndrome has been resolved, the loss of muscle cells is irreversible.
Some health-care professionals consider shin splints a compartment Mild cases of compartment syndrome may be treated by immobilizing
syndrome of the anterior compartment of the leg. and resting the affected limb. In more severe cases, the fascia may
have to be incised (cut) to relieve the pressure and decompress the
Generally, compartment syndrome is a condition in which the blood
affected compartment.
vessels within a limb compartment become compressed as a result of
mck78097_ch12_354-396.indd 391 2/14/11 3:26 PM

Lumbricals Adductor hallucis
Flexor hallucis
brevis
Flexor digiti
minimi brevis
Tendon of flexor
hallucis longus
Flexor digitorum
brevis Tendons of flexor
digitorum longus
Abductor hallucis
Quadratus plantae
Abductor digiti
minimi Abductor digiti
minimi (cut)
Abductor hallucis
(cut)
Calcaneus
(a) Layer 1 (superficial) (b) Layer 2 (deep) (c) Layer 3 (deeper)
Plantar interossei
Dorsal interossei
Figure 12.23
Plantar Intrinsic Muscles of the Foot. These muscles move the
toes. (a) Superficial, (b) deep, and (c) deeper layers of the intrinsic
muscles of the right foot. (d) Plantar and (e) dorsal views of the
deepest layers.
(d) Layer 4 (deepest), plantar view (e) Layer 4 (deepest), dorsal view
The plantar surface of the foot is supported by the plan- The second layer (deep to the first) consists of the thick,
tar aponeurosis formed from the deep fascia of the foot. This medial quadratus plantae, which attaches to the tendons of
aponeurosis extends between the phalanges of the toes and the the flexor digitorum longus. Note how the flexor digitorum
calcaneus. It also encloses the plantar muscles of the foot. longus tendons attach to the toes at an angle. The quadratus
The plantar muscles are grouped into four layers plantae pulls on the slanted flexor digitorum longus tendons in
(figure 12.23). The first layer of muscles is the most super- a posterior fashion so that toes 2–5 may be flexed properly, not
ficial. It includes the flexor digitorum brevis that attaches to at an angle. In addition, this layer contains the four lumbrical
the middle phalanges of the toes, so it can flex the MP and PIP muscles, small muscles that attach to the tendons of the flexor
joints (but not the DIP joints) of toes 2–5. Also included in this digitorum longus and serve to flex the MP joints and extend the
layer are the abductor hallucis, which abducts the great toe DIP and PIP joints of toes 2–5.
(1), and the abductor digiti minimi, which abducts the small The third layer (deeper) contains the adductor hallucis,
toe (5). which adducts the great toe (1). Also in this layer are the medial
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Table 12.14 Intrinsic Muscles of the Foot

DORSAL SURFACE (TOE EXTENSORS)
Extensor hallucis brevis Extends MP joint of great toe (1) O: Calcaneus and inferior extensor Deep fibular nerve (S1–S2 fibers)
retinaculum
I: Proximal phalanx of great toe (1)
Extensor digitorum brevis Extends MP, PIP, and DIP joints of O: Calcaneus and inferior extensor Deep fibular nerve (S1–S2 fibers)
toes 2–4 retinaculum
I: Middle phalanges of toes 2–4
PLANTAR SURFACE (TOE FLEXORS, ADDUCTORS, ABDUCTORS)
Layer 1 (Superficial)
Flexor digitorum brevis Flexes MP and PIP joints of toes 2–5 O: Calcaneus Medial plantar nerve (S2–S3)
I: Middle phalanges of toes 2–5
Abductor hallucis Abducts great toe (1) O: Calcaneus Medial plantar nerve (S2–S3)
I: Medial side of proximal phalanx
of great toe (1)
Abductor digiti minimi Abducts toe 5 O: Calcaneus (inferior surface Lateral plantar nerve (S2–S3)
tuberosity)
I: Lateral side of proximal phalanx
of toe 5
Layer 2 (Deep)
Quadratus plantae (plan ́tē) Pulls on flexor digitorum longus O: Calcaneus, long plantar ligament Lateral plantar nerve (S2–S3)
planta = sole of foot tendons to flex toes 2–5 I: Tendons of flexor digitorum
longus
Lumbricals Flexes MP joints and extends PIP O: Tendons of flexor digitorum Medial plantar nerve (1st lumbrical);
and DIP joints of toes 2–5 longus lateral plantar nerve (2nd–4th
I: Tendons of extensor digitorum lumbricals)
longus
Layer 3 (Deeper)
Adductor hallucis Adducts great toe (1) O: Transverse head: Capsules of MP Lateral plantar nerve (S2–S3)
joints III–V
Oblique head: Bases of
metatarsals II–IV
I: Lateral side of proximal phalanx
of great toe (1)
Flexor hallucis brevis Flexes MP joint of great toe (1) O: Cuboid and lateral (3rd) Medial plantar nerve (S2–S3)
cuneiform bones
I: Proximal phalanx of great toe (1)
Flexor digiti minimi brevis Flexes MP joint of toe 5 O: Metatarsal V Lateral plantar nerve (S2–S3)
I: Proximal phalanx of toe 5
Layer 4 (Deepest)
Dorsal interossei Abducts toes O: Adjacent sides of metatarsals Lateral plantar nerve (S2–S3)
I: Sides of proximal phalanges of
toes 2–4
Plantar interossei Adducts toes O: Sides of metatarsals III–V Lateral plantar nerve (S2–S3)
I: Medial side of proximal
phalanges of toes 3–5
flexor hallucis brevis and the lateral flexor digiti minimi brevis,
which flex the great toe (1) and the small toe (5), respectively. The W H AT D I D Y O U L E A R N?
fourth layer (deepest) consists of four dorsal interossei and three ●
13 What are the basic functions of the hamstring muscles?
plantar interossei. The dorsal interossei abduct the toes, while the
plantar interossei adduct the toes. ●
14 Identify the muscles that flex the knee joint/leg.
Table 12.14 summarizes the characteristics of the intrinsic ●

15 What is the action of the muscles in the lateral compartment of
muscles of the foot, and table 12.15 groups the leg and intrinsic the leg?
foot muscles according to their common actions on the foot. ●
16 Identify the intrinsic muscles of the foot that extend the toes.
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Table 12.15 Summary of Leg and Foot Muscle Actions at the Foot and Toes
FOOT
Dorsiflexion Plantar Flexion Eversion Inversion
Tibialis anterior Gastrocnemius Fibularis longus Tibialis posterior
Extensor digitorum longus Soleus Fibularis brevis Tibialis anterior
(Extensor hallucis longus) Flexor digitorum longus (Fibularis tertius)
(Fibularis tertius) Flexor hallucis longus
Tibialis posterior
(Fibularis longus)
(Fibularis brevis)
(Plantaris)
TOES
Extension Flexion Abduction Adduction
Extensor digitorum longus Flexor digitorum longus Abductor hallucis Adductor hallucis
Extensor hallucis longus Flexor hallucis longus Abductor digiti minimi Plantar interossei
Extensor digitorum brevis Flexor digitorum brevis Dorsal interossei
Extensor hallucis brevis Flexor hallucis brevis
Flexor digiti minimi brevis
Boldface indicates a prime mover; others are synergists. Parentheses indicate only a slight effect.
Clinical Terms
adductor strain Extreme thigh abduction results in pulled adductor hallux valgus (hal ́ŭks văl ́gus; valgus = turned outward) Deviation
muscles, especially the adductor longus. of the tip of the great toe to the medial side of the foot away
electromyography (ē-lek ́trō-mı̄-og ́ră-fē) Recording of electrical from the second toe.
activity generated in a muscle for diagnostic purposes.
Chapter Summary
■ The appendicular muscles stabilize and help move the pectoral and pelvic girdles, and move the upper and lower limbs.
12.1 Muscles That ■ Five groups of muscles are associated with pectoral girdle and upper limb movement: muscles that move (1) the pectoral
Move the Pectoral girdle; (2) the glenohumeral joint/arm; (3) the elbow joint/forearm; (4) the wrist joint, hand, and fingers; and (5) the
Girdle and Upper intrinsic muscles of the hand.
Limb 355
12.1a Muscles That Move the Pectoral Girdle 355
■ Anterior thoracic muscles protract, rotate, and/or depress the scapula; one anterior thoracic muscle depresses
the clavicle.
■ The posterior thoracic muscles elevate, retract, and/or rotate the scapula.
12.1b Muscles That Move the Glenohumeral Joint/Arm 360
■ The pectoralis major flexes the arm, and the latissimus dorsi extends it, while both adduct and medially rotate it.
■ Seven scapular muscles move the humerus, individually or together, causing abduction, adduction, extension, flexion,
lateral rotation, or medial rotation of the arm.
■ Collectively, the subscapularis, supraspinatus, infraspinatus, and teres minor are called the rotator cuff muscles. They
provide strength and stability to the glenohumeral joint, and move the humerus.
12.1c Arm and Forearm Muscles That Move the Elbow Joint/Forearm 363
■ The principal flexors are on the anterior side of the arm, and the principal extensors are on the posterior side of
the arm.
■ Muscles that move the forearm are the biceps brachii (flexes and supinates) and the triceps brachii (extends).
■ The pronator teres and pronator quadratus cause pronation only of the forearm; the supinator opposes this movement.
mck78097_ch12_354-396.indd 394 2/14/11 3:26 PM

12.1 Muscles That 12.1d Forearm Muscles That Move the Wrist Joint, Hand, and Fingers 366
Move the Pectoral ■ Strong fibrous bands, called the flexor retinaculum and the extensor retinaculum, hold tendon sheaths of the forearm
Girdle and Upper muscles close to the skeletal elements of the wrist.
Limb (continued)
■ Superficial muscles of the forearm function coordinately to flex the wrist; some also cause abduction and adduction of
the wrist. The intermediate and deep anterior forearm muscles flex the wrist and the MP and IP joints.
■ Extension of the wrist and fingers is provided by the extensor muscles of the forearm. Some also cause abduction or
adduction of the hand. The deep posterior compartment muscles are primarily wrist and finger extensors.
12.1e Intrinsic Muscles of the Hand 374
■ Intrinsic muscles of the hand are small muscles entirely within the hand and divided into three groups: (1) the thenar
group, (2) the hypothenar group, and (3) the midpalmar group between the thenar and hypothenar groups.
12.2 Muscles That ■ Four groups of muscles are associated with the pelvis and lower limb: muscles that move (1) the hip joint/thigh,
Move the Pelvic (2) the knee joint/leg, and (3) leg muscles, as well as (4) the intrinsic muscles of the foot.
Girdle and Lower
Limb 377 12.2a Muscles That Move the Hip Joint/Thigh 377
■ Muscles that act on the thigh (femur) originate on the surface of the ossa coxae (pelvis) and insert on the femur.
■ Anterior compartment muscles flex the thigh.
■ There are three gluteal muscles: The gluteus maximus extends and laterally rotates the thigh; the gluteus medius and
minimus are powerful abductors of the thigh.
■ The deep gluteal muscles contain the lateral rotators of the thigh.
■ The posterior compartment (hamstring) muscles extend the thigh.
■ Medial compartment muscles adduct the thigh, and most also flex the thigh.
■ The lateral compartment muscle (tensor fasciae latae) abducts the thigh.
12.2b Thigh Muscles That Move the Knee Joint/Leg 381
■ The quadriceps femoris extends the leg.
■ The sartorius muscle flexes both the thigh and the leg.
■ Some medial thigh muscles also flex the leg.
■ The extensors of the thigh and flexors of the leg, termed the hamstrings, occupy the posterior compartment.
12.2c Leg Muscles 385
■ The anterior compartment muscles dorsiflex the foot and extend the toes. One muscle also inverts the foot.
■ Lateral compartment muscles evert and plantar flex the foot.
■ Posterior compartment muscles plantar flex the foot.
■ Deep posterior compartment muscles either flex the leg or plantar flex the foot, and either flex the toes or invert
the foot.
12.2d Intrinsic Muscles of the Foot 391
■ Dorsal muscles extend the toes.
■ The four layers of plantar muscles flex, extend, abduct, and/or adduct the toes.
Challenge Yourself
Matching Multiple Choice
Match each numbered item with the most closely related lettered Select the best answer from the four choices provided.
item.
______ 1. The dorsal interossei muscles in the hand
______ 1. serratus anterior a. elevates scapula a. adduct fingers 2–5. c. flex the PIP and DIP
joints.
______ 2. rhomboid major b. protracts scapula
b. abduct fingers 2–5. d. extend the MP joints.
______ 3. teres minor c. adducts and flexes thigh
______ 2. The contraction of the ______ causes medial
______ 4. deltoid d. connective tissue band rotation of the thigh.
a. pectineus c. gluteus minimus
______ 5. pronator teres e. plantar flexes foot
b. obturator externus d. gracilis
______ 6. extensor retinaculum f. extends leg
______ 3. Muscles in the anterior compartment of the leg
______ 7. quadriceps femoris g. prime abductor of humerus a. evert the foot.
b. dorsiflex the foot and extend the toes.
______ 8. pectineus h. dorsiflexes foot
c. plantar flex the foot.
______ 9. soleus i. laterally rotates humerus d. flex the toes.
______ 10. tibialis anterior j. pronates forearm
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______ 4. All of the following muscles flex the forearm except the Content Review
a. brachialis.
1. The trapezius can perform what types of movements?
b. biceps brachii.
c. brachioradialis. 2. What movements are possible at the glenohumeral joint, and
d. anconeus. which muscles perform each of these movements?
3. Identify the compartments of the arm, the muscles in each
______ 5. The quadriceps femoris is composed of which of the
compartment, and their function.
following muscles?
a. biceps femoris, rectus femoris, vastus lateralis, 4. Compare and contrast the flexor digitorum superficialis and
and gracilis the flexor digitorum profundus; where does each insert, how
b. vastus lateralis, vastus medialis, rectus femoris, are their tendons interrelated, and what muscle actions do
and vastus intermedius they perform?
c. semimembranosus, semitendinosus, and biceps 5. What is the primary function of the retinacula in a limb?
femoris 6. What muscles are responsible for thigh extension? Which of
d. popliteus, gracilis, and sartorius these is the prime mover of thigh extension?
______ 6. Thumb opposition is caused by contraction of the 7. Which muscles abduct the thigh, and where are they located?
______ muscle. 8. What leg muscles are contracted when you are sitting at
a. flexor digiti minimi brevis your desk?
b. opponens pollicis
9. What leg muscles allow a ballet dancer to rise up and
c. extensor pollicis longus
balance on her toes?
d. adductor pollicis
10. Which muscles are responsible for foot inversion, and what
______ 7. The ______ flexes the knee and causes a slight muscles are antagonists to those that invert the foot?
medial rotation to “unlock” the knee joint.
a. sartorius Developing Critical Reasoning
b. soleus
1. Edmund suffers an injury to the anterior compartment
c. tensor fasciae latae
of his thigh that results in paralysis of the muscles of
d. popliteus
this compartment. What muscle movements will be
______ 8. Eversion of the foot is caused by the contraction of compromised?
the ______ muscle. 2. After falling while skateboarding, Karen had surgery on
a. soleus her elbow. During her recovery, she must visit the physical
b. plantaris therapist to improve muscle function around the elbow.
c. fibularis brevis Develop a series of exercises that may improve all of Karen’s
d. gastrocnemius elbow movements, and determine which muscles are being
______ 9. Which muscles originate on the ischial tuberosity helped by each exercise.
and extend the thigh plus flex the leg? 3. Why is it more difficult for Eric to lift a heavy weight
a. adductor muscles when his forearm is pronated than when it is in the supine
b. fibularis muscles position?
c. hamstring muscles
d. quadriceps muscles
______ 10. The ______ causes plantar flexion of the foot.
a. iliopsoas
b. gastrocnemius
c. fibularis tertius
d. vastus intermedius
Answers to “What Do You Think?”

1. The supraspinatus muscle is the most commonly injured 3. The iliopsoas cannot flex the leg, because this muscle does
rotator cuff muscle, due in part to its location in the narrow not cross over the knee joint.
space between the acromion and the humerus. Repetitive arm 4. Remember that there are leg muscles that also move the
motions impinge (pinch) the muscle in this narrow space, toes. In this case, the extensor digitorum longus (a leg
and may eventually lead to tears of the muscle or tendon. muscle) attaches to toes 2–5 and helps move them all.
2. The brachialis is an anterior arm muscle. Since anterior arm
muscles tend to flex the elbow joint, we can surmise that
the brachialis flexes the elbow joint.
www.mhhe.com/mckinley3 Enhance your study with practice tests and activities to

assess your understanding. Your instructor may also recommend the interactive eBook,
individualized learning tools, and more.
mck78097_ch12_354-396.indd 396 2/14/11 3:26 PM

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MUSCUL AR SYSTEM

12.1 Muscles That Move the Pectoral Girdle and Upper

MODULE 6: MUSCUL AR SYSTEM

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Trapezius Levator scapulae

classified according to their location in the thorax as either ante-

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Retracted scapulae Protracted scapulae

(a) Retraction and protraction of scapula

Elevators Depressors Superior rotators Inferior rotators

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Biceps brachii, Serratus anterior

(a) Anterior view

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Rhomboid minor Supraspinatus

Rhomboid major Infraspinatus

Deltoid Teres minor

(b) Posterior view

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Table 12.1 Thoracic Muscles That Move the Pectoral Girdle

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(a) Anterior view (b) Posterior view

Subscapularis Supraspinatus Infraspinatus and teres minor

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Table 12.2 Muscles That Move the Glenohumeral Joint/Arm

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Table 12.3 Summary of Muscle Actions at the Glenohumeral Joint/Arm

12.1c Arm and Forearm Muscles That Move

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Biceps brachii, long head

Biceps brachii, short head

Biceps brachii tendon

(b) Anterior muscles

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(a) Posterior view

Superficial Deep Figure 12.8

Triceps brachii, medial head

(b) Posterior muscles

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Figure 12.9 Medial

three-headed muscle on the posterior surface of the arm. It is Interosseous

Some forearm muscles pronate or supinate the forearm

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Table 12.4 Muscles That Move the Forearm

Table 12.5 Summary of Muscle Actions at the Elbow Joint/Forearm

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View of Palmaris longus

Extensor carpi radialis

Abductor pollicis longus

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Medial epicondyle Common flexor tendon

(a) Right anterior forearm, superficial view Figure 12.11

Flexor digitorum Flexor digitorum profundus

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Flexor pollicis longus tendon Flexor digitorum superficialis tendon

Flexor retinaculum covering carpal

Common flexor synovial sheath

(a) Carpal tunnel, anterior view