KIN 2E03 - MSK Lower Extremity

Tibialis Anterior

Anterior compartment of leg

Origin: Upper two thirds of the lateral surface of the tibia, the crural interosseous membrane, and the highest part of the superficial crural fascia

Insertion: Medial and plantar surface of the medial cuneiform & medial base of the 1st metatarsal

Action:

Dorsiflexion (talocrural joint)

Inversion (subtalar joint)

Extensor Hallucis Longus

Anterior compartment of leg

Origin: middle third of the medial surface of fibula, crural interosseous membrane

Insertion: Dorsal aponeurosis of the great toe and the base of its distal phalanx

*Actions:

Dorsiflexion (talocrural),

both eversion and inversion depending on initial position of foot

Extension of MTP and IP*

Extensor Digitorum Longus

Anterior compartment of leg

Origin: lateral tibial condyle, head of fibula, medial surface of the fibula, and crural interosseous membrane

Insertion: dorsal aponeuroses of the 2nd to 5th toes and the bases of the distal phalanges of 2nd through 5th toes

*Action:

Dorsiflexion (talocrural)

Eversion (subtalar)

Extension (MTP & IP joints of 2nd and 5th toes)*

Fibularis (peroneus) Longus

Lateral compartment of leg

Origin: head of fibula, proximal 2/3 of lateral surface of fibula

Insertion: plantar side of the medial cuneiform, base of the 1st metatarsal

Action:

Plantar Flexion (talocrural)

Eversion (subtalar)

Supports transverse arch of foot

Fibularis (peroneus) brevis

Lateral compartment of leg

Origin: distal half of lateral side of fibula

Insertion: 5th metatarsal tuberosity

*Action:

Plantar flexion (talocrural)

eversion (subtalar)*

Tibialis Posterior

Deep posterior leg

Origin: crural interosseous membrane and the adjacent borders of the tibia and fibula

Insertion: Navicular Tuberosity, medial intermediate and lateral cuneiforms; bases of the 2nd to 5th metatarsals

Action:

Plantar Flexion (talocrural)

Inversion (subtalar)

supports longitudinal and transverse arches of the foot

Flexor hallucis Longus

deep posterior leg

Origin: Distal 2/3 of the posterior surface of the fibula

Insertion: Base of the distal phalanx of the great toe

*Action:

Plantar flexion (talocrural, MTP and IP of great toe)

inversion (subtalar)

supports medial longitudinal arch of foot*

Flexor digitorum longus

Deep posterior leg

Origin: middle third of the posterior surface of the tibia

Insertion: bases of the 2nd through 5th distal phalanges

*Action:

Plantar flexion (talocrural, MTP and IP of 2nd to 5th toes)

Inversion (subtalar)*

Plantaris

Superficial Posterior leg

Origin: lateral epicondyle proximal to the lateral head of gastrocnemius

Insertion: calcaneal tuberosity via the calcaneal (achilles) tendon

*Action:

negligible.

Prevents compression of the posterior leg musculature during knee flexion*

Gastrocnemius

Superficial Posterior leg

Origin: medial head: medial epicondyle of femur

lateral head: lateral epicondyle of femur

Insertion: calcaneal tuberosity via the calcaneal (achilles) tendon

Action: Plantar Flexion (talocrural)

Flexion (knee)

Soleus

Superficial Posterior leg

Origin: posterior surface of the head and neck of the fibula; attached to the soleal line of the tibia via a tendinous arch

Insertion: calcaneal tuberosity via the calcaneal (achilles) tendon

Action:

Plantar flexion (talocrural)

Vastus Medialis

Anterior compartment thigh (part of quadriceps femoris)

Origin: medial lip of the linea aspera, distal part of the intertrochanteric line

Insertion: both sides of the tibial tuberosity on the medial and lateral condyles via the medial and lateral longitudinal patellar retinacula

Action:

Extension (knee)

Vastus intermedius

Anterior thigh (part of quadriceps femoris)

Origin: anterior side of the femoral shaft

Insertion: on the tibial tuberosity via the patellar ligament

*Action:

Extension (knee)*

Vastus lateralis

Anterior thigh (part of quadriceps femoris)

Origin: lateral lip of the linea aspera, lateral surface of the greater trochanter

Insertion: both sides of the tibial tuberosity on the medial and lateral condyles via the medial and lateral longitudinal patellar retinacula

*Action:

Extension (knee)*

Rectus Femoris

Anterior thigh (part of quadriceps femoris)

Origin: anterior inferior iliac spine, acetabular roof of the hip joint

Insertion: on the tibial tuberosity via the patellar ligament

Action:

Flexion (hip joint)

Extension (knee)

Sartorius

Anterior thigh

Origin: anterior superior iliac spine

Insertion: medial to the tibial tuberosity

Action:

Flexion (hip and knee)

Abduction (hip)

External/lateral rotation (hip)

Internal/medial rotation (knee)

Psoas Major

Anterior thigh (inner hip)

Origin: superficial: lateral surfaces of T12 vertebral body, the L1-L4 vertebral bodies and the associated intervertebral disks

Deep: costal processes of the L1-L5 vertebrae

Insertion: lesser trochanter of the femur as iliopsoas

Actions:

flexion (hip)

External rotation (hip)

Biceps Femoris (both heads)

Posterior thigh

Origin:

Long head: ischial tuberosity sacrotuberous ligament

Short head: lateral lip of the linea aspera in the middle of the third of the femur

Insertion: Head of fibula

Action:

Long head - adduction (hip)

- hip extension

- stabilizes pelvis in sagittal plane

Flexion (knee)

External/lateral rotation (knee)

Semitendinosus

Posterior thigh

Origin: ischial tuberosity and sacrotuberous ligament

Insertion: medial to the tibial tuberosity in the pes anserinus

*Action:

Adduction (hip)

Hip extension

hip stabilizer in sagittal plane

Flexion (knee)

Internal/medial rotation (knee)*

Semimembranosus

Posterior thigh

Origin: ischial tuberosity

Insertion: medial tibial condyle, oblique popliteal ligament, popliteus fascia

Action:

Adduction (hip)

Hip extension

Hip stabilizer in sagittal plane

flexion (knee)

Internal rotation (knee)

Popliteus

posterior thigh

Origin: lateral femoral condyle, posterior horn of the lateral meniscus

Insertion: posterior tibial surface

*Action:

Flexes and unlocks the knee by internally rotating the tibia relative to femur *

Adductor Magnus

Medial Thigh

Origin: inferior pubic ramus, ischial ramus, and the ischial tuberosity

Insertion:

deep part: medial lip of linea aspera

superficial part: adductor tubercle of femur

Action:

Adduction (hip)

Extension (hip)

slight flexion (hip)

internal rotation (superficial part at hip)

stabilizes pelvis in coronal and sagittal plane

Adductor longus

Medial thigh

Origin: superior pubic ramus and anterior side of the symphysis

Insertion: linea aspera: medial lip in the middle third of the femur

Action:

Adduction (hip up to 70 degrees)

flexion (hip up to 70 degrees)

extension (past 80 degrees of flexion)

stabilizes pelvis in coronal and sagittal plane

Adductor brevis

Medial thigh

Origin: inferior pubic ramus

Insertion: linea aspera: medial lip in the upper third of the femur

*Action:

Adduction (hip up to 70 degrees)

flexion (hip up to 70 degrees)

extension (past 80 degrees of flexion)

stabilizes pelvis in coronal and sagittal plane*

Pectineus

Medial thigh

Origin: pecten pubis

Insertion: pectineal line and the proximal linea aspera of the femur

*Action:

Adduction(hip)

external rotation (hip)

slight flexion(hip)

stabilizes pelvis in the coronal and sagittal planes*

Gracilis

Medial thigh

Origin: inferior pubic ramus below the pubic symphysis

Insertion: medial border of the tibial tuberosity

Action:

Adduction (hip)

Flexion(hip and knee)

internal rotation (knee)

Obturator Externus

Medial thigh

Origin: outer surface of the obturator membrane and its bony boundaries

Insertion: trochanteric fossa of the femur

*Action:

Adduction(hip)

external rotation (hip)

stabilizes the pelvis in the sagittal plane*

Gluteus Maximus

Superficial gluteal

Origin: lateral part of the dorsal surface of the sacrum, posterior part of the gluteal surface of the ilium, also from the thoracolumbar fascia

Insertion:

Upper fibers: iliotibial tract

Lower fibers: gluteal tuberosity

Action:

extension (hip)

externally rotation (hip)

Pelvic stabilizer in both sagittal and coronal planes

Upper fibers: abduction

Lower fibers: adduction

Gluteus Medius

Superficial gluteal

Origin: gluteal surface of the ilium

Insertion: lateral surface of the greater trochanter of the femur

Action:

Abduction (hip)

pelvic stabilizer in coronal plane

Anterior part: flexion and internal rotation

Posterior part: extension and external rotation

Gluteus Minimus

Superficial gluteal

Origin: gluteal surface of the ilium

Insertion: anterolateral surface of the greater trochanter of the femur

*Action:

abduction (hip)

pelvic stabilizer in coronal plane

Anterior part: flexion and internal rotation

Posterior part: extension and external rotation*

Tensor Fascia Latae

Superficial gluteal

Origin: anterior superior iliac spine

Insertion: iliotibial tract

Action:

Tenses the fascia latae

abduction (hip)

flexion (hip)

internal rotation (hip)

Piriformis

Superficial gluteal

Origin: pelvic surface of the sacrum

Insertion: Apex of the greater trochanter of the femur

Action:

External rotation (hip)

abduction (hip)

extension (hip)

stabilizes hip joint

Gemellus Superior

Deep Gluteal

Origin: ischial spine

Insertion: jointly with obturator internus tendon (medial surface, greater trochanter)

Action:

external rotation (hip)

adduction (hip)

extension (hip)

Also abduction depending on position of joint

Gemellus Inferior

Deep Gluteal

Origin: ischial tuberosity

Insertion: jointly with obturator internus tendon (medial surface, greater trochanter)

*Action:

external rotation (hip)

adduction (hip)

extension (hip)

Also abduction depending on position of joint*

Obturator Internus

Deep gluteal

Origin: inner surface of the obturator membrane and its bony boundaries

Insertion: medial surface of the greater trochanter

Action:

external rotation (hip)

adduction (hip)

extension (hip)

Also abduction depending on position of joint

Quadratus Femoris

Deep gluteal

Origin: lateral border of the ischial tuberosity

Insertion: intertrochanteric crest of the femur

*Action:

External rotation (hip)

Adduction (hip)*

Base of 1st metatarsal (2)

Tibialis Anterior

Fibularis (peroneus) longus

Talus: neck (2)

Anterior talofibular

Anterior tibiotalar

Talus: posterior process (2)

Posterior talofibular

Posterior tibiotalar

Tuberosity of the 5th metatarsal (1)

Fibularis (peroneus) brevis

Navicular tuberosity (3)

Tibialis Posterior

Tibionavicular

Plantar Calcaneonavicular

Calcaneal tuberosity (2)

Gastrocnemius

Soleus

Sustentaculum tali of calcaneus (2)

Tibiocalcaneal

Plantar Calcaneonavicular

Medial tibial condyle (5)

Medial to the lateral tibial condyle, proximal to the medial malleolus

Medial Collateral (MCL)

Semimembranosus

Vastus Medialis (?)

Vastus Lateralis(?)

medial meniscus

Medial longitudinal patellar retinaculum

Lateral tibial condyle (2)

Lateral to the medial tibial condyle, proximal to the tibial tuberosity

Extensor Digitorum Longus

Vastus lateralis (?)

Lateral longitudinal patellar retinaculum

Intercondylar areas (4)

Medial to the lateral condyle, lateral to medial condyle, proximal to the soleal line

Anterior cruciate (ACL) ligament

Posterior cruciate (PCL) ligament

anterior/posterior horns (ends) of lateral/medial menisci

Tibial Tuberosity (1)

Anterior, distal to the tibial condyles

Patellar ligament

Head of fibula (4)

Lateral, proximal to lateral malleolus, medial to tibia

Lateral Collateral (LCL)

Extensor Digitorum Longus

Fibularis (peroneus) Longus

Biceps Femoris (both heads)

Medial Malleolus (4)

medial to the tibiofibular syndesmosis, distal to tibial tuberosity, proximal to calcaneus

Deltoid ligament:

Tibionavicular

Anterior Tibiotalar

Tibiocalcaneal

Posterior Tibiotalar

Lateral Malleolus (3)

Distal to lateral malleolar fossa/fibula head, lateral, proximal to calcaneus, lateral to talus

Anterior Talofibular

Calcaneofibular

Posterior talofibular

Greater trochanter (5)

Lateral to head to femur, proximal to medial/lateral epicondyle of femur and lesser trochanter

Ischiofemoral ligament

Vastus lateralis

Gluteus Medius

Gluteus Minimus

Piriformis

Lesser trochanter (2)

Distal and posterior to head of fibula, medial to greater trochanter, lateral to ischial tuberosity

Iliopsoas

Intertrochanteric line (3)

Medial to greater trochanter, travels medially and distal to lesser trochanter

Iliofemoral

Pubofemoral

Vastus Medialis

Linea aspera (5)

Posterior aspect of shaft of femur, distal to lesser trochanter, proximal to lateral and medial epicondyles

Biceps Femoris (short head)

Adductor Magnus (deep part)

Adductor longus

Adductor brevis

Pectineus

Medial Femoral condyle (2)

Distal aspect of femur, medial to lateral femoral condyle

Posterior Cruciate (PCL)

Medial Collateral (MCL)

Lateral femoral condyle (2)

Distal aspect of femur, lateral to medial femoral condyle

Anterior Cruciate (ACL)

Lateral Collateral (LCL)

Anterior superior iliac spine (3)

Anterior aspect of iliac, inferior to iliac crest, lateral to iliac tuberosity, superior to anterior inferior iliac spine

Sartorius

Tensor Fascia Latae

Inguinal Ligament

Anterior inferior iliac spine (1)

Anterior aspect of iliac, superior to acetabulum, inferior to ASIS

Rectus Femoris

Ischial tuberosity (4)

Inferior aspect of pelvic girdle, medial to lesser trochanter of femur, lateral to obturator foramen

Sacrotuberous ligament

Semitendinosus

Semimembranosus

Adductor Magnus

Quadratus Femoris

Obturator foramen (1)

Lateral to pubic ramus, medial to ischial tuberosity, inferior to Acetabulum

Obturator internus

Superior pubic ramus (2)

Medial to ischial tuberosity, superior to obturator foramen

Adductor longus

Pubofemoral

Inferior pubic ramus (1)

Inferior to superior pubic ramus, medial to ischial tuberosity

Adductor Brevis

Anterior Talofibular

Foot and Ankle

Proximal: Lateral malleolus: anterior aspect

Distal: Talus, neck, lateral side

Limits:

inversion while plantarflexed

Excessive anterior translation (while plantarflexed)

Calcaneofibular

Foot and ankle

Proximal: Lateral malleolus: inferior aspect

Distal: Calcaneus: lateral side

Limits: inversion while dorsiflexed

Posterior Talofibular

Foot and ankle

Proximal: Lateral malleolus: posterior aspect

Distal: Talus, posterior process, lateral side

Limits:

inversion while dorsiflexed

Posterior talar translation

Tibionavicular

Foot and ankle

Proximal: Medial malleolus: anterior aspect

Distal: Navicular Tubercle

Limits: Eversion when plantarflexed

Anterior Tibiotalar

foot and ankle

Proximal: Medial malleolus: anterior aspect

Distal: Talus, neck, medial side

Limits:

Eversion when plantarflexed

anterior talar translation (during plantarflexion)

Tibiocalcaneal

Foot and ankle

Proxima;: Medial malleolus: inferior aspect

Distal: Sustentaculum Tali

Limits: eversion

Posterior Tibiotalar

Foot and ankle

Proximal: Medial malleolus: posterior aspect

Distal: Talus, posterior process, medial side

Limits:

everison when dorsiflexed

Posterior translation when dorsiflexed

Plantar Calcaneonavicular

Foot and ankle

Proximal: Calcaneus: Sustentaculum Tali

Distal: Navicular Tubercle

Limits: over flattening of medial longitudinal arch

Plantar Fascia (Plantar Aponeurosis)

Foot and ankle

Proximal: Calcaneal tuberosity

Distal: 5 individual slips, just distal to the MTP joints

Medial Collateral (MCL)

Knee

Proximal :Medial epicondyle of femur

Distal: Medial tibial condyle, anterior side

Limits: Valgus Knee

Lateral Collateral (LCL)

Knee

Proximal: Lateral epicondyle of femur

Distal: Head of fibula

Limits: Varus knee

Anterior Cruciate (ACL)

Knee

Proximal: Lateral femoral condyle: medial side

Distal: Anterior intercondylar area of tibia

Limits:

anterior translation of tibia relative to femur

(posterior translation of femur relative to tibia)

Internal rotation

Posterior Cruciate (PCL)

Knee

Proximal: Medial femoral condyle: lateral side

Distal: Posterior intercondylar area of tibia

Limits:

posterior translation tibia to femur

(anterior translation femur to tibia)

External rotation

Iliofemoral

Hip

Inverted Y shape

Medial: Ilium, lateral surface, near Anterior inferior iliac spine (AIIS)

Distal: Intertrochanteric line of femur

Limits: extension

Ischiofemoral

Hip

Medial: Ischium, posterior surface

Distal: Greater trochanter, medial aspect

Limits: internal rotation of hip

Pubofemoral

Hip

Medial: Superior ramus of the pubis

Distal: Intertrochanteric line: inferior aspect

Limits: abduction

Inguinal Ligament

Hip

Medial: Anterior Superior Iliac Spine (ASIS)

Distal: Pubic Tubercle

Tibio-fibular mortise

concave like shape that the tibia-fibula will grab the talus on its sides with.

Talo-Crural Joint

Primary actions:

Dorsiflexion (if muscle in front of joint center)

plantarflexion (if behind)

Inferior Tibio-Fibular Joint

Anterior and posterior

Ligaments are wide, broad and dense

No movement - stabilizer

A very solid joint

Is continuous with the interosseous membrane

Ligaments of Inferior Tibio-Fibular joint

A syndesmosis of 3 ligaments:

Anterior Inferior Tibio-Fibular ligament

Posterior Inferior Tibio-Fibular ligament

Interosseous Inferior Tibio-Fibular ligament

These hold onto talus so it stays stable

Sub- Talar Joint

Talus and calcaneus

Primary action: inversion and eversion

Talus motion

The dome of talus is wider anteriorly than it is posteriorly.

Dorsiflexion:

talus slides backwards into mortise therefore inferior tibio-fibular joint ligament separates to accommodate

Plantarflexion: talus translates anteriorly

Thee main foot contact points

1st MTP joint

5th MTP joint

Calcaneus

Arches of foot

Transverse metatarsal arch

Lateral longitudinal arch

Medial longitudinal arch

Medial Longitudinal Arch

Highest arch, most clinical info

-when talus sits down it pushes the arch down

ligaments stop over flattening of the arch

-Plantar Fascia (aponeurosis)

-Plantar Calcaneo-navicular Ligament

Plantar Fascia (Aponeurosis)

- Passive tissue

- Broader than ligament, spreads across bottom of foot like a web

- supports medial longitudinal arch

Pes Cavus

Over arched foot

Pes planus

Flat foot

Foot Pronation

Action:

foot lowering and arch dropping

Shock absorption

Foot Supination

Action:

gathering arch back into arched position

Rigidity to be like lever

Retinacula

Superior and inferior on ankle joint

-web like tissue

Action: to keep tendons in place

Knee Joint's

Patellofemoral and Tibiofemoral joints

Primary actions:

Flexion and extension (tibia relative to femur)

Rotation (internal, external)

Plus: locking mechanism of knee

Locking mechanism of knee

Full extension of knee, locked into place by externally rotating tibia

Menisci

Fibrocartilage- fill space, little disks, compress when put load on them

Horns are primary attachments of the femur

Red zone--get blood supply

White zone--do not get blood supply

widens contact area of femur to tibia = increased force distribution between condyles

Varus

"bow legged"

opens the lateral side

LCL limits

Valgus

"Knock knee"

Opens the medial side

MCL limits

Patella

Sesamoid bone

Floats for the first 20 - 30 degrees of knee flexion

the quadriceps tendon limit movement

Lifts the quadriceps attachment causing to have greater range of motion