Muscles and Topography of the Upper and Lower Limb

MUSCLES AND TOPOGRAPHY
OF THE UPPER AND LOWER
LIMBS
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PLAN
1. Muscles of the upper limb.
2. Muscles and topography of the shoulder girdle.
3. Muscles and topography of the upper arm.
4. Muscles and topography of the forearm.
5. Muscles and topography of the hand.
6. Fasciae of the upper limb.
7. The synovial bursae of the upper limb.
8. The muscles of the lower limb.
9. Muscles and topography of the pelvic girdle.
10.Muscles and topography of the thigh.
11.Muscles and topography of the leg.
12.Muscles and topography of the foot.
13.The synovial bursae of the lower limb.

MUSCLES OF THE UPPER LIMB
The muscles of the upper limb can be classified into the muscles of the shoulder joint,
the muscles of the arm, the muscles of the forearm and the muscles of the hand.
Muscles of the Shoulder joint
The Dorsal group The Ventral group
1.The deltoid muscle
2.The supraspinatus muscle
3.The infraspinatus muscle
4.The teres minor muscle
5. The teres major muscle
1.The subscapular muscle

The axillary cavity
Walls. The axillary cavity has four
walls formed by the following
muscles:
• anterior — pectoralis major and
minor;
• posterior — subscapularis, teres
major, and latissimus dorsi;
• medial — serratus anterior;
• lateral — short head of the biceps
brachii, coracobrachialis, and
humerus.
On the posterior wall are 2 openings:
• quadrangular opening bounded
by the teres major (below),
subscapularis (above), long head
of the triceps brachii (medially),
and humerus (laterally);
• triangular opening bounded by
the teres major (below),
subscapularis (above), and long
head of the triceps brachii
(laterally).

Triangles of the anterior
wall of the axillary cavity.
For better orientation, three
triangles are distinguished
on the anterior wall of the
axillary cavity:
• clavipectoral triangle
resides between the clavicle
and the upper border of the
pectoralis minor;
• pectoral triangle
corresponds to the
projection of the pectoralis
minor;
• subpectoral triangle located
between the inferior borders
of the pectoralis minor
(above) and pectoralis major
(below); laterally it is
bounded by the deltoid.
Between the pectoralis
major and deltoid there is a
deep deltoidopectoral
groove.

Muscles of the Upper Arm
The muscles of the upper arm are concerned with the movements at the shoulder and
elbow joints on the frontal axis and, therefore, are situated on the anterior (two
flexors) and posterior (two extensors) surfaces of the upper arm and attach to the
bones of the forearm.
Anterior muscles
of the Upper Arm
(flexors)
Posterior muscles of the Upper Arm
(extensors)
1.The biceps brachii muscle
2.The coracobrachial muscle
1.The triceps brachii muscle
2.Elbow’s muscle

The topography of the upper arm
• Radial canal is located behind the humerus. It is bounded by the
radial groove of the humerus in the front and by the triceps brachii
in the back. The canal has a spiral path. The radial canal begins on
the medial surface of the arm between the medial and lateral
heads of the triceps brachii and exits on the lateral surface of the
arm between the brachialis and brachio-radialis.
The canal gives passage to the radial nerve and a. profunda
brachii.
• Medial bicipital groove lies medially between the biceps brachii
and brachialis; it transmits the main neurovascular bundle of the
upper arm.
• Lateral bicipital groove resides laterally between the biceps brachii
and brachialis; it gives passage to the cephalic vein.

Muscles of the Forearm
The muscles of the forearm are separated into two groups according to position and
function: the anterior group is composed of flexors and pronators, the posterior group
is composed of extensors and supinator.
Each group consists of a superficial and deep layers.
The Anterior group, Superficial layer
(flexors)
The Anterior Group,
Deep layer (flexors)
1. The round pronator muscle
2.The radial flexor of the wrist
3.The long palmar muscle
4.The ulnar flexor of the wrist
5.The superficial flexor of the fingers
6.The long flexors of the thumb
7.The deep flexor of the fingers
8.The square pronator muscle

The Posterior group
The muscles of the posterior group of the forearm are divided into two subgroups:
radial and ulnar. The first occupies the anterolateral surface of the forearm, while the
second occupies the posterior surface and is formed by the superficial and deep
layers.
The Posterior Radial Group The Posterior Ulnar group
1.The brachioradial muscle
2.The long radial extensor of the wrist
3.The short radial extensor of the wrist
Superficial layer
4.The common extensor of the fingers
5.The extensor of the little finger
6.The ulnar extensor of the wrist
Deep layer
7. The supinator muscle
8. The long abductor of the thumb
9. The short extensor of the thumb
10. The long extensor of the thumb
11. The extensor of the index

The
topography
of the
forearm
• The cubital fossa is bounded by the brachialis above; below it is bounded by
the brachioradialis (laterally) and pronator teres (medially).
Within the borders of the cubital fossa there are two grooves located on each
side from the brachialis — medial cubital groove and lateral cubital groove.

The topography of the forearm
• The ulnar groove of the forearm lies
between the flexor carpi ulnaris and
flexor digitorum superficialis.
       It transmits the ulnar nerve, artery,
and vein.
• The median groove of the forearm
resides in the lower part of the
forearm between the flexor carpi
radialis and flexor digitorum
superficialis.
       It contains the median nerve.
• The radial groove runs between the
flexor carpi radialis and
brachioradialis.    It transmits the
radial artery, vein, and nerve.

Muscles of the Hand
The Thenar muscles of
theHand
The Hypothenar muscles
of the Hand
Muscles of the Hollow of
the Hand
1.The short abductor of the
thumb
2.The short flexor of the
thumb
3.The opponens muscle of
the thumb
4.The adductor muscle of
the thumb
1.The short palmar muscle
2.The abductor of the little
finger
3.The short flexor of the
little finger
4.The opponens muscle of
the little finger
1.The lumbrical (worm-
like) muscles
2. The interossei muscles
-The palmar interossei
muscles
-- The dorsal interossei
muscles

The topography of the hand
The carpal canal is located in the region of the carpus underneath the flexor
retinaculum. It gives passage to the tendons of the flexor digitorum superficialis,
flexor digitorum profundus, flexor pollicis longus, and the median nerve.
• On both sides from the carpal canal, the flexor retinaculum splits and forms
another two canals — the radial carpal canal and ulnar carpal.
• The radial carpal canal gives passage to the tendon of the flexor carpi radialis,
while the ulnar carpal canal transmits the ulnar artery, vein, and nerve.
The fibrous sheaths of the digits of the hand are formed by the dense fibrous lamina,
which fuse with the bones. As a result, osteofibrous canals are formed, which
contain tendons of the flexors covered by the synovial sheath. Each fibrous sheath
consists of the anular part and cruciform part, the less dense cruciform part is
situated in the joint region.

Six canals on the dorsal surface of the wrist joint are counted from the radial to the
ulnar border and transmit following tendons:
1. the first canal transmits the
tendons of the m. abductor
pollicis longus and m. extensor
pollicis brevis;
2. the second canal transmits the
tendons of the m.m. extensor
carpi radialis longus and
brevis;
3. the third canal transmits the
tendon of the m. extensor
pollicis longus, and crosses the
preceding canal obliquely;
4. the fourth canal transmits the
tendons of the m. extensor
digitorum and m. extensor
indicis;
5. the fifth canal transmits the
digiti minimi;
6. the sixth canal transmits the
carpi ulnaris.

FASCIAE OF THE UPPER LIMB
• 1. The deltoid fascia
• 2. The supraspinous fascia
• 3. The infraspinous fascia
• 4. The brachial fascia
• 5. The antebrachial fascia
• 6. The palmar aponeurosis
• 7. The deep palmar fascia
• 8. The dorsal fascia of the hand
• 9. flexor retinaculum
• 10.extensor retinaculum

THE SYNOVIAL BURSAE OF THE UPPER LIMB
1. subdeltoid bursa resides between the deltoid and greater
tubercle of the humerus;
2. subacromial bursa lies under the acromion of the scapula;
3. subcutaneous acromial bursa lies superficially under the skin in
the region of the acromion of the scapula;
4. subtendinous bursa of subscapularis is located near the
attachment point of the subscapularis; the bursa communicates
with the cavity of the shoulder joint;
5. subtendinous bursa of latissimus dorsi resides under the tendon
near the point of attachment of the muscle on the humerus; there
is also another small bursa under the tendon of the teres major.
In the region of the elbow joint the following bursae are found:
6. bicipitoradial bursa resides between the tendon of the biceps
brachii and the tuberosity of the radius;
7. subcutaneous olecranon bursa wide, lies under the skin of the
olecranon.

Clinical applications
The inflammatory diseases of the synovial bursae
(bursitis) can be acute or chronic. In acute bursitis, pus
can accumulate in the bursa, which requires surgical
intervention. Chronic bursitis (gygroma) is often an
occupational disease. In the shoulder girdle area,
inflammatory processes are most common in the
subcutaneous acromial bursa and in the subdeltoid
bursa (among porters). In the region of the elbow joint,
the subcutaneous olecranon bursa may become
inflamed (among tanners and etchers).

THE MUSCLES OF THE LOWER LIMB
All other muscles of the lower limb are autochthonous. They are grouped into the
muscles of the pelvic girdle, thigh, leg, and foot.
MUSCLES OF THE PELVIC GIRDLE
The muscules of the pelvic girdle are divided into anterior group (flexors) and
posterior group (extensors, rotators and abductors), which pass from the pelvic girdle
to the femur and allow movements at the hip joint.
The Anterior Group The Posterior group
1.The iliopsoas muscle
1) The greater psoas muscle
2) The iliacus muscle
2.The lesser psoas muscle
1.The gluteus maximus muscle
2.The gluteus medius muscle
3. The gluteus minimus muscle
4.The tensor fascial latae muscle
5.The piriformis muscle
6.The obturator internus muscle
7-8.The gemellus superior and inferior muscles
9.The quadratus femoris muscle
10.The obturator externus muscle

THE TOPOGRAPHY OF THE LOWER LIMB
On the lower limb there are several topographo-anatomical structures, which
have a clinical significance.
THE REGION OF THE PELVIC GIRDLE
– The suprapiriform foramen resides in the region of the ischium
within the greater sciatic foramen above the piriformis. It gives
passage to the superior sciatic vessels and nerve.
– The infrapiriformf oramen is located below the piriformis in the same
area. This foramen transmits the inferior sciatic vessels and nerves.
– The obturator canal is bounded by the obturator groove of the pubis,
obturator membrane, and by the obturator internus.
The canal transmits the obturator vessels and nerve.
• Clinical applications. The supra- and infra- piriform foramina as well as
the obturator canal may serve as the exit location for the hernias (sciatic
and obturator hernias). The purulent masses from the pelvis may spread
through these openings into the gluteal region.

MUSCLES OF THE THIGH
The muscles of the thigh are divided into three groups: anterior (extensors of the leg
and flexors of the thigh), posterior (flexors of the leg and extensors of the thigh) and
medial (adductors). The last group acts only on the hip joint, where as the first two
groups act on the knee joint also.
The Anterior Group
(extensors)
The Posterior Group
(flexors)
1.The quadriceps femoris muscle
1) The rectus femoris muscle
2) The vastus lateralis muscle
3) The vastus medialis muscle
4) The vastus intermedius muscle
2.The sartorius or tailor’s muscle
3.The articular muscle of the knee
1.The semitendinosus muscle
2.The semimembranosus muscle
3.The biceps femoris muscle
4.The popliteus muscle

THE REGION OF THE THIGH
The muscular space resides below the inguinal
ligament on the lateral side.
It is bounded:
• medially — by the thickened region of the
fascial layer — iliopectineal arch, in the
front and above — by the inguinal ligament,
• laterally and in the back — by the ilium.
The muscular space gives passage to the
iliopsoas and femoral nerve.
The vascular space resides behind the inguinal
ligament, medially from the muscular space,
from which it is separated by the
iliopectineal arch.
• In the front and above the vascular space is
bounded by the inguinal ligament,
• posteriorly — by the thick periosteum of
the pubis,
• laterally — by the iliopectineal arch,
• medially — by the lacunar ligament.
The vascular space transmits the femoral artery
(resides laterally) and femoral vein (resides
medially).

THE REGION OF THE
THIGH
The femoral triangle resides on
the anterior surface of the
thigh.
• It is bounded by the inguinal
ligament above, sartorius
laterally, and adductor
longus medially.
• The triangle contains the
main neurovascular bundle
of the thigh and lymph
nodes.

THE REGION OF THE
THIGH
The femoral ring resides behind the
inguinal ligament, medially from the
femoral vein; the ring is a part of the
vascular space. The femoral vein
forms the lateral wall of the femoral
ring. From the medial side it is
bounded by the arcuate fibers,
which descend from the inguinal
ligament and called the lacunar
ligament. The anterior wall of the
femoral ring is formed by the
inguinal ligament, and posterior —
by the thickened periosteum of the
pubis.
• The femoral canal. The femoral ring is a weak spot under the inguinal ligament, which can serve as
an exit location for the femoral hernias. When the hernia passes through the femoral canal is
formed. The internal aperture of the femoral canal is the femoral ring. Passing through the femoral
ring, the hernia lies between the superficial and deep layers of the fascia lata, which form the
anterior and posterior walls of the femoral canal. The lateral wall of the canal is formed by the
femoral vein. The hernias emerge onto the skin through the saphenous opening in the superficial
layer of the fascia lata, which becomes the external aperture of the femoral canal.

The iliopectineal groove lies between the pectineus and
iliopsoas within the borders of the femoral triangle.
The anterior femoral groove passes between the vastus
medialis and adductor longus.
It is bounded by the vastus medialis laterally and
adductor longus and magnus medially.
It is anterior wall is represented by the tendineous plate,
which bridges over these muscles, lamina
vastoadductoria.
At the downward-facing apex of the femoral triangle the anterior
femoral groove transforms into an adductor canal.
• The canal leads into the popliteal fossa, where it opens. This
opening is formed by the cleft in the tendon of the adductor
magnus — adductor hiatus. The canal gives passage to the
femoral vessels and saphenous nerve.

MUSCLES OF THE LEG
The muscles of the leg are divided into three groups:
the anterior (extensors), the posterior and the lateral (flexors).
The Anterior Group
(extensors)
The Lateral Group
(flexors)
The Posterior Group
(flexors)
1.The anterior tibial
muscle
2.The long extensor of the
toes
3.The peroneus tertius
muscle
4.The long extensor of the
big toe
1.The long peroneal
muscle
2.The short peroneal
muscle
Superficial layer
1.The triceps surae muscle
2.The gastrocnemius muscle
3.The soleus muscle
4.The plantaris muscle
Deep layer
1.The long flexor of the toes
2.The posterior tibial muscle
3.The long flexor of the big toe

THE REGION OF THE LEG
The popliteal fossa resides in the back on
the border between the thigh and the
leg. It is rhomboid in shape.
• Above, it is bounded by the biceps
femoris (laterally), semitendinosus and
semimembranosus (medially).
• Below, the fossa is bounded by the two
heads of the gastrocnemius.
• The bottom of the popliteal fossa
(anterior wall) is formed by the popliteal
surface, facies poplitea, of the femur
and the capsule of the knee joint.
• The main neurovascular bundle passes
through the popliteal fossa. The lymph
nodes and vessels occupy the fossa
along with the adipose tissue.

THE REGION OF THE LEG
The cruropopliteal canal leads from the popliteal fossa into the leg. It resides in the back
between the deep muscles of the leg and the soleus.
• Therefore, its anterior wall is formed by the tibialis posterior, while the anterior wall
— by the soleus.
• The canal has three openings — superior, inferior, and anterior. The superior opening
of the canal is bounded by the popliteus in the front and by the tendineous arch of
the soleus in the back.
• The inferior opening resides between the tibialis posterior and soleus, where the
latter becomes the Achilles tendon. The anterior opening is located in the upper part
of the interosseous membrane of the leg.
The inferior musculoperoneal canal is the branch of the cruropopliteal canal in the
lateral direction. Its anterior wall is formed by the posterior surface of the fibula,
while its posterior wall — by the flexor hallucis longus. It transmits the fibular
vessels.
The superior musculoperoneal canal is an independent canal, which resides in the upper
third of the leg between the lateral surface of the fibula and peroneus longus. It gives
passage to the superficial peroneal nerve.

MUSCLES OF THE FOOT
• The foot, like the hand, in addition to tendons of the long muscles of the
leg descending on it, has its own short muscles among which are dorsal
and plantar muscles.
The Dorsal muscles of the Foot
• The short extensor of the toes (m. extensor digitorum brevis) lies on the
dorsal surface of the foot under the tendons of the extensor digitorum
longus.
The Plantar muscles of the Foot
• The muscle of the sole of the foot form three groups: medial (muscles of
the big toe), lateral (muscles of the little toe) and middle group situated
in the middle of the sole.

Synovial bursae on the lower limb:
In the region of the hip joint:
1. subcutaneous trochanteric bursa spacious, resides under the skin in the region of
the greater trochanter of the femur;
2. trochanteric bursae of gluteal muscles located between the greater trochanter
and tendons of each of the gluteal muscles — gluteus maximus, medius, and
minimus;
3. bursa of piriformis resides between its tendon and the greater trochanter;
4. sciatic bursa of obturator intemus lies where the muscle passes around the
margin of the lesser sciatic notch;
5. subtendinous bursa of iliacus resides betweenthe tendon of the iliopsoas and
lesser trochanter of the femur.
Clinical applications. In the region of the hip joint, inflammations (bursitis) of the
subtendineous bursa of the iliac occur, which cause painful sensations. Frequently,
the subcutaneous trochanteric bursa becomes inflamed. In this case, pain and
swelling are located in the region of the greater trochanter.

In the region of the knee joint:
1. suprapatellar bursa resides under the tendon of the quadriceps femoris; it is
extensively connected with the knee joint (see the knee joint);
2. subcutaneous prepatellar bursa spacious, resides under the skin in front of the
patella;
3. subcutaneous infrapatellar bursa resides under the skin below the patella;
4. deep infrapatellar bursa resides between the tendon of the quadriceps femoris
(patellar ligament, Iig. patellae) and tibia;
5. anserine bursa lies under the tendineous extension of the sartorius, gracilis, and
semitendinosus near their attachments on the tibia;
6. subtendinous bursae reside near the points of attachments of the tendons of the
biceps femoris and lateral head of the gastrocnemius.
• Clinical applications. In the region of the knee joint, inflammations of the
subcutaneous prepatellar bursa are fairly common (prepatellar bursitis), which are
characterized by the appearance of a round fluctuating swelling in the front of the
patella. In the popliteal fossa, inflammation of the bursae located under the muscular
tendons also occurs.

In the region of the talocrural joint:
• subcutaneous calcaneal bursa resides under the skin in the region of the calcaneal
tuberosity;
• bursa of tendo calcaneus (Achilles) lies between the calcaneal tendon and the
calcaneus;
• subcutaneous bursae of malleoli reside under the skin in the regions of the
malleoli.

THE END

Muscles and Topography of the Upper and Lower Limb

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