Facial Muscles. 1

Oral cavity. 1

Muscles of mastication. 1

Forehaead. 2

Nose. 2

Facial Muscles
Muscle	Nerve	Origin	Insertion	Action	Needle
Oral cavity
Genioglossus	Hypoglossal			Major extrinsic muscle of the tongue – protrudes tongue.	Insert from beneath the anterior mandible, just lateral to the midline.

Muscles of mastication
Masseter	TGN V3 Mandibular division	Zygomatic arch	Angle of mandible	Elevates and protrudes mandible	2 FB ant. To angle of jaw and 1-2 FB cephalad.
Temporalis		Temporal foss	Coronoid process of mandible	Elevates and retracts mandible
Lateral pterygoid		Sphenoid bone	Head of mandible (near TMJ)	Initiates mouth opening by protruding mandible
Medial pterygoid		Sphenoid bone	Angle of mandible (on interior surface)	Elevates the mandible
Forehead
Frontalis	Facial nerve, frontal branch				2 FB above the middle of the eyebrow
Orbital opening/Palpebral fissure
Orbicularis oculi	Facial nerve, temporal branch	Medial orbit	Skin around margin of orbit	Closes eyelids	Lat. inferior ridge of eye socket
Corrugator supercilii				Wrinkles the eyebrow – Frown Thoughtful brow
Depressor supercilli				Lowers the eyebrow

Nose
Nasalis		Maxilla	Nasal cartlidges	Narrows the nose
Procerus		Continuation of frontalis	Superior nose	Wrinkles root of nose (by pulling nose up and eyebrows down)
Levator labii superioris alaeque nasi				Elevates upper lip and nasal alae Disapproval
Mouth
Orbicularis oris				Closes the mouth (and protrudes/purses lips)
Buccinator				Muscle of the cheek – presses check against teeth – aids in eating. Satisfaction
Zygomaticus major		Zygomatic arch	Corner of mouth	Smiling

Risorius		Platysma	Corner of mouth	Draws sides of mouth laterally Purposeful action
Levator labii superioris		Maxilla	Upper lip	Elevates lip
Levator anguli oris				Pulls the corner of the mouth upwards Self-satisfaction
Depressor anguli oris				Pulls corners of mouth down Sadness
Depressor labii inferioris				Pulls lower lip down Perseverence
Mentalis	Facial nerve, mandibular branch	Mandible	Skin of chin	Pulls the skin on the chin upwards – elevating and protruding the lower lip	Insert into chin, have patient purse lips

Neck
Sterocleido-mastoid
Splenius capitus	Middle cervical spinal nerves	Spinous processes of superior 6 thoracic vertebrae	Mastoid process and lateral 1/3 or superior nuchal line	Laterally flexes and rotates the head to the same side
Posterior scalene	Spinal nerves C7 and C8	Transverse processes of C4-C6 vertebrae	External border of 2^nd rib	Flexes neck laterally, elevates 2^nd rib
Middle scalene			Sup. Surface of 1^st rib	Flexes neck laterally, elevates 1st rib
Anterior scalene	Spinal nerves C4, C5, C6		1^st rib	Elevates 1^st rib, laterally rotates neck
Semispinalis capitus		Transverse processes of thoracic spine	Occipital bone	Neck extension

Upper limb

Shoulder Gridle

Muscle

Nerve

Trunk

Division

Cord

Origin

Insertion

Action

Needle

Trapezius

Accessory

Cranial nerve

Nuchal ligament, spinous processes C7-C12

Clavicle, acromion, spine of scapula

Elevates, retracts and rotates scapula

At point where shoulder meets the neck.

Rhomboids

Dorsal Scapular

Off C5 nerve root

Spinous processes C7-T5

Medial border of scapular – from spine down.

Retracts scapula and rotates the glenoid cavity down. Fixes scapula to chest wall.

Mid-point b/n medial border of scapula and spine. Ask patient to brace shoulder backwards

Levator Scapulae

Dorsal Scapular

Off C4 and C5 nerve root

Transverse processes C1-C4

Superior, medial scapular

Elevates scapula and tilts its glenoid cavity inferiorly by rotating scapula

Serratus Anterior

Long thoracic

Off C5, C6, C7

Superior 8 or 9 ribs

Costal aspect of medial scapular

Protracts and stabilizes scapula, assists in upward rotation.

Over 6^th rib, mid-axillary line.

Latissimus dorsi (C6, C7, C8)

Thoracodorsal

All 3

Posterior

Spinous processes from T7 down

Medial, proximal humerus

Extends, adducts and medially rotates shoulder

Lat. to tip of scapula at post. Axillary line. Have the pt. extend shoulder while adducted.

Supraspinatus

Suprascapular

Upper

Supraspinous fossa of scapula

superior facet of greater tubercle of humerus

Abduction of arm (first 30deg)

Stablisation of humerus

Just sup. And med. To mid-point of scapular spine.

Infraspinatus

Suprascapular

Upper

Infraspinous fossa of the scapula

middle facet of greater tubercle of the humerus

Lateral rotation of arm and stabilizes humerus

1-2FB below mid-point of scapular spine.

Subscapularus

Upper/lower subscapular

Upper

Posterior

Subscapular fossa

Lesser tubercle of humerus

Internally (medially) rotates humerus; stabilizes shoulder

Teres major

Lower subscapular

Upper

Posterior

Posterior aspect of the inferior angle of the scapula

Medial lip intertubercular sulcus of the humerus

Internal rotation (medial rotation) of the humerus

Teres minor

Axillary

Upper

Posterior

lateral border of the scapula

inferior facet of greater tubercle of the humerus

Externally rotates arm, stabilises humerus

2/3 along line from inf. Point of scapular to acromium.

Deltoid

Axillary

Upper

Posterior

Lateral third of the clavicle, acromion, spine of the scapula

Deltoid tuberosity of humerus

shoulder abduction, flexion and extension

4cm distal to acromium in midpoint.

Pectoralis major

Lateral, medial pectoral

All three

Lateral, medial

Medial half of the clavicle, anterior surface of the sternum, the superior six costal cartilages

bicipital groove of the humerus

As a whole, adducts and medially rotates the humerus. It also draws the scapula anteriorly and inferiorly.

Ant. Inf shoulder (5 FB below humeral head)

Have pt abduct shoulder.

Pectoralis minor

Lateral, medial pectoral

All three

Lateral

Third to fifth ribs, near their costal cartilages

Medial border and superior surface of the coracoid process of the scapula

Stabilizes the scapula by drawing it inferiorly and anteriorly against the thoracic wall

Muscle

Nerve

Trunk

Cord

Division

Origin

Insertion

Action

Biceps brachii

Musc.

Lateral

Short head: coracoid process of the scapula.

Long head: supraglenoid tubercle

Radial tuberosity and bicipital aponeurosis into deep fascia on medial part of forearm

Flexes elbow (when supine) and supinates forearm

Midpoint b/n biceps tendon and shoulder

Brachialis

Musc.

Lateral

Distal anterior humerus

Coronoid process and tuberosity of ulna

Flexes forearm (in all positions)

Median

Muscle

Nerve

Trunk

Division

Cord

Origin

Insertion

Action

Needle

Pronator teres

(PT)

Median

Upper, Middle

Lateral

Medial epicondyle of the humerus

(+some radial and ulna)

Mid lateral radius

Pronates and flexes forearm

2 FB distal to mid-point b/n biceps tendon and med. Epicondyle.

Flexor carpi radialis

(FCR)

Median

Upper, Middle

Lateral

Base of 2nd Metacarpal

Flexes and abducts hand at wrist

4 FB distal to mid-point b/n biceps tendon and med. Epicondyle. On line to mid point of wrist.

Palmaris longus

Median

Flexor retinaculum and palma aponeurosis

Flexes hand and tightens palmar aponeurosis

Flexor digitorum superficialis

(FDS)

Median

Middle, Lower

Lateral, Medial

Middle phalanges

Flexes middle phalanges at PIP and Proximal phalanges at MCP joints

Just med. To mid-point b/n biceps tendon and mid wrist.

Flexor digitorum profundus (II and III)

(FDP)

Median

(AIN)

Middle, Lower

Lateral, Medial

Proximal Ulna & interosseous membrane

Distal phalanges

Flexes distal phalanges at DIP

3-4 FB distal to olecranon, on ulnar side of forearm (deep)

Flexor pollicis longus

(FPL)

Median

(AIN)

Middle, Lower

Lateral, Medial

Radius and interosseous membrane

Base of distal phalanx of thumb

Flexes phalanges of thumb (1st digit)

Over radius 1/3 of way up to elbow.

Pronator quadratus

(PQ)

Median

(AIN)

Middle, Lower

Lateral, Medial

Distal anterior ulna

Distal anterior radius

Pronates forearm

Arm half way supinated. Dorsal arm, 3 Fb proximal to styloids at mid-point. – deep.

Lumbricals I, II

Median (RB)

Lower

Medial

FDS tendon in palm

Lateral prox. phalanx (ext. expansion)

Flex MCP and extend PIPs

Abductor pollicis brevis

(ABP)

Median (RB)

Lower

Medial

Flex ret. Scaphoid, trapezium

Lateral side of base of prox. phalanx

Abduct and oppose thumb

Lat. thenar eminence

Flexor pollicis brevis

Median (RB)

(+/- ulnar)

Lower

Medial

Med-lateral side of base of prox. phalanx

Flexes thumb

Med. To midpoint of thenar eminence

Opponens pollicis

Median (RB)

Lower

Medial

Lateral 1^st MCP

Opposes thumb

Lat. thenar eminence, just ant. To 1^st metacarpal.

Ulnar

Muscle

Nerve

Trunk

Division

Cord

Origin

Insertion

Action

Needle

Flexor carpi ulnaris

(FCU)

Ulnar

Lower

Medial

Medial epicondyle of humerus

Pisiform, hamate, 5^th MC.

Flexes and adducts wrist

Med. Forearm, mid point b/n elbow and wrist

Flexor digitorum profundus IV and V

(FDP)

Ulnar

Lower

Medial

Proximal Ulna and interosseous membrane

Distal phalanges

Flexes distal phalanges at DIP

3-4 FB distal to olecranon, on ulnar side of forearm (superficial)

Abductor digiti minimi

(ADM)

Ulnar

Lower

Medial

Pisiform

Med. Base, prox. phalanx little finger

Adducts digit 5

Med. Hand, mid point of 5^th metacarpal.

Lumbricales III and IV

Ulnar

Lower

Medial

Tendons of FDP

Lat. prox. phalanx

Flex MCPJ (and extend IPJs)

Palmar interossei

Ulnar

Lower

Medial

Palmar surfaces 2^nd, 4^th 5^th MC

Base of prox. phalanx

Adducts digits (aids flexion)

First dorsal interosseous (FDI)

Ulnar

Lower

Medial

Adjacent metacarpals

Base prox phalanges

Abduct digits ( aids flexion)

Dorsal hand half way between 1^st and 2^nd MCPJs.

Adductor pollicis

Ulnar

Lower

Medial

2^nd and 3^rd metacarpals

Med. Base, prox. phalanx of thumb

Adducts thumb

Radial

Muscle

Nerve

Trunk

Division

Cord

Origin

Insertion

Action

Needle

Triceps

Radial

Upper, Middle

Posterior

Humerus and scapula

Ulna – olecranon

Extends forearm

Mid point b/n lat. epicondyle and shoulder

Brachioradialis

(BR)

Radial

Upper

Lateral supracondylar ridge of humerus

Lateral, distal radius

Flexes forearm

3-4 FB dis. To mid-point b/n biceps tendon and lat. epicondyle

Anconeus

2 FB distal to olecranon, just above the ulna

Extensor carpi radialis longus

(ECRL)

Radial

Upper, Middle

Lateral supracondylar ridge of humerus

Base of 2nd metacarpal

Extend and abduct hand at wrist

Just above lat. epicondyle

Extensor carpi radialis brevis (ECRB)

Radial

Supinator

Radial -

deep branch

Upper, Middle

Lateral epicondyle of humerus + prox ulna

Prox. third of radius

Supinates forearm

Extensor carpi ulnaris

(ECU)

Radial – Posterior. Interosseous.

Middle, Lower

Base of 5th metacarpal

Extends and adducts hand at wrist

Mid point of ulnar on dorsal arm (slightly towards radius)

Extensor digitorum (communis)

Middle, Lower

Lateral epicondyle of humerus

Extensor expansions of digits

Extends digits at MCP joints + extends hand at wrist

3-4 FB distal to olecranon, 3 FB above the ulna

Abductor pollicis longus

Middle, Lower

Posterior ulna

Base of 1st metacarpal

Abducts thumb and extends it at carpometacarpal joint

Extensor pollicis longus

Middle, Lower

Posterior ulna

Base of distal phalanx of thumb

Extends distal phalanx of thumb at MCP and IP joints

Extensor pollicis brevis

Extensor indicis

(EIP)

Middle, Lower

Posterior ulna

Extensor expansion of 2nd digit

Extends 2nd digit and helps extend hand at wrist

2 FB prox and slightly medial to ulnar styloid on dorsum.

For needle insertion anatomy see Muscle diagrams

Lower Limb
Femoral Nerve
Muscle	Nerve	L2	L3	L4	L5	S1	S2	Origin	Insertion	Action	Needle
Iliopsoas	Femoral /Lumbar plexus	*						Sides of T12-L5 vertebrae +Iliac fossa	Lesser trochanter of femur	Flex thigh at the hip	2-3 FB lat. to the femoral pulse and just below the inguinal ligament
Sartorius	Femoral			*				ASIS	Superior, medial tibia	Flexes, Abducts and laterally rotates thigh, flexes knee
Rectus femoris	Femoral							Ant. Inf. Iliac Spine	Patella	Extend leg at knee joint (Recutus femoris also flexes hip)	Ant. Thigh, mid-point b/n hip and knee.
Vastus lateralis	Femoral							Greater trochanter			Lat. thigh, 4-5 FB proximal to lateral knee
Vastus intermedius	Femoral							Anterior femur			Deep to vastus lat. and rectus fem.
Vastus medialis	Femoral							Medial femur			Med. Thigh 3-4 FB prox. to the med. Knee.
Obturator Nerve
Adductor longus	Obturator							Pubis	Middle third of femur	Adducts thigh	Medial thigh 3-4 FB distal to the pubis. Hard to differentiate the individual muscles – treat as a group.
Gracillis	Obturator							Inferior pubic ramus	Superior, medial tibia	Adducts thigh, flexes leg, medial rotation
Adductor magnus	Obturator							Ischial tuberosity	Medial femur	Adducts and flexes thigh
Adductor brevis	Obturator							Inferior pubic ramus	Proximal medial femur	Adducts and flexes thigh
Gluteal Muscles
Gluteus maximus	Inferior gluteal							Ilium, sacrum, coccyx	Iliotibial tract and proximal femur	Extends thigh (esp. from flexed), lateral rotation	Upper outer quadrant of the buttock (have patient extend thigh or squeeze buttocks)
Gluteus medius	Superior gluteal							Ilium, proximal	Lateral greater trochanter	Abduct and medially rotate thigh, keep pelvis level when opposite foot is raised	2-3 FB distal to midpoint of iliac crest (post. To line b/n ASIS and greater trochanter)
Gluteus minimus	Superior gluteal							Ilium distal	Anterior greater trochanter
Piriformis	Spinal roots							Anterior sacrum	Superior greater trochanter	Lat. rotate extended thigh, abduct flexed thigh
Tensor fascia lata	Superior gluteal							ASIS	Iliotibial band (attaches to proximal tibia)	Thigh flexor, some medial rotation Tenses iliotibial band to stabilise thigh on knee.	2 cm lat. and 5cm distal to ASIS (just anterior to greater trochanter).
Sciatic Nerve
Muscle	Nerve	L2	L3	L4	L5	S1	S2	Origin	Insertion	Action	Needle
Semimembranousus	Sciatic – tibial division			*				Ischial tuberosity	Medial, superior tibia	Extend thigh, flex and medially rotate leg	3-4 FB pox. To med. Knee, lat. to the tendon of semitendinous
Semitendinosus	Sciatic – tibial division			*				Ischial tuberosity	Medial, superior tibia	Extend thigh, flex and medially rotate leg	Mid point b/n med. Knee and ischial tuberosity.
Biceps femoris	Sciatic Long head: Tibial division Short Head: Common peroneal division							Long head: Ischial tuberosity Short head: distal femur	Fibula head	Extends thigh, flexes and laterally rotates leg	Short head: 3-4 FB prox. to lat. knee. Medial to the tendon of long head. Long head: Mid point between lateral knee and ischial tuberosity.
Peroneal Nerve
Muscle	Nerve	L2	L3	L4	L5	S1	S2	Origin	Insertion	Action	Needle
Tibialis anterior (TA)	Deep peroneal							Proximal, lateral tibia	Medial cuneiform and base 1^st metacarpal	Dorsiflexion and foot inversion	Just lat. to tibial crest 2/3^rd way up leg
Extensor digitorum longus	Deep peroneal					*		Proximal, lateral, tibia and fibular	Middle and distal phalanges of lateral 4 digits	Extends lateral 4 digits and dorsiflexes ankle	3-4 FB lat. to tbial crest, mid leg. B/n TA and PL.
Exensor hallucis longus (EHL)	Deep peroneal							Mid fibular	Base of distal phalanx of great toe	Extends great toe and dorsiflexes ankle
Extensor digitorum brevis (EDB)	Deep peroneal							Dorsal surface of calcaneus	Proximal dorsal region of middle phalanges 2, 3 and 4 (EHB is an extension of the same muscle to 1^stphalanges)	Aids extension of digits 2-4 (N.B digit 5 extended by EDL only)	2-3 FB below lateral malleolus on dorsolateral foot
Extensor hallucis brevis (EHB)	Deep peroneal							Dorsal surface of calcaneus		Aids extension of great toe	3-4 FB above ankle, just lat. to TA tendon
Peroneus longus	Superficial peroneal							Superior, lateral fibular	Base of 1^st metatarsal (crosses under sole of foot)	Evert and weakly plantarflex the foot	Lat. calf, 3-4 FB below fibuar head
Peroneus brevis	Superficial peroneal							Inferior, lateral fibular	Base of 5^th metatarsal	Evert and weakly plantarflex the foot
Tibial Nerve
Muscle	Nerve	L2	L3	L4	L5	S1	S2	Origin	Insertion	Action	Needle
Gastrocnemius (medial)	Tibial						*	Medial condyle of femur	Calcaneal (Achilles tendon)	Plantarfexion of foot Flexion of knee	Pos-med. calf
Gastrocnemius (lateral)	Tibial							Lateral condyle of femur
Soleus	Tibial							Fibular head, proximal tib and fib		Plantarflexes foot	Medial to the tibia, below half way point of leg, angle back.
Tibialis posterior	Tibial							Interosseous membrane	Inferior surface of tarsal bones and metatarsals	Plantarflexes foot and inverts ankle	Just medial to the tibia, below half way point of leg, deep to FDL.
Flexor digitorum longus	Tibial							Medial posterior tibia	Base of phalanges of lat. 4 digits	Flexes lat. 4 digits and ankle. Supports arch of foot.	Just medial to the tibia, below half way point of leg. (ant. to soleus)
Abductor hallucis (brevis)	Tibial (Medial plantar)							Calcaneus	Medial, base of prox phalanx of great toe	Abducts and flexes great toe	Mid point of medial foot.
Flexor halluces brevis	Tibial (Medial plantar)							Cuboid and lat. cuneiforms	Base of proximal phalanx of great toe	Flexes great toe	Medial sole, just below the ball of the foot, med. to FHL tendon.
Dorsal interosseous	Tibial (Lateral plantar)							Metatarsal bases	Proximal phalax digit 2-4.	Abduct digits (2-4) and flex CTP joints 1^st dorsal interosseuous is to 2^nd toe.
Abductor digiti quinti (minimi)	Tibial (Lateral plantar)							Calcaneus	Lateral, prox phalanx 5^th digit	Abducts and flexes 5^th digit	Lat. foot, 2-3 FB prox to base of 5^th metatarsal.

For needle insertion anatomy see Muscle diagrams

Nerve	Roots	Plexus	Motor	Sensory
Nerves of the shoulder
Dorsal scapular	C5	Off C5 root (ventral ramus)	Rhomboids
Long thoracic	C5-C7	Ventral rami of roots	Serratus anterior
Suprascapular nerve	C5, C6	Only branch of the upper trunk of brachial plexus	Supraspinatus Infraspinatus	AC joint Glenohumeral joint
Subscapular – upper
Subscapular - lower

Nerves of the upper limb
Nerve	Roots	Plexus	Motor	Sensory

Axillary	C5-6	Superior trunk Posterior division Posterior cord	Deltoid	Patch on lateral arm
Musculocutaneous	C5-6	Superior trunk Lateral cord	Biceps Brachialis	Lateral forearm (Lateral cutaneous nerve of the forearm/Lateral antebrachial)
Median	C5-T1	Mid/Lower trunk Anterior divisions Lateral/Med Cords	Pronator teres Flexor carpi radialis Palmaris longus Flexor digitorum superficialis Anterior interosseous nerve - Flexor digitorum profundus - Flexor pollicis longus - Pronator quadratus Hand - Lumbricals - Opponens pollicis - Abductor pollicis brevis - Flexor pollicis brevis	Lateral 3.5 digits Palm (palmar branch)
Ulnar	C8-T1	Lower trunk Anterior division Medial Cord	Flexor carpi ulnaris Flexor digitorum profundus Hand - Interossei - Lumbricals (medial) - Abductor digiti minimi - Oppones digiti minimi - Flexor digiti minimi - Adductor pollicis - +/- Flexor pollicis brevis	Median 1.5 digits Palm (palmar branch) Dorsum of hand (dorsal branch)
Radial	C5-C8	Mid/Lower trunk Posterior Divisions Posterior Cords	Triceps Brachioradialis Supinator Abductor pollicis longus Extensor - carpi radialis (longus and brevis) - carpi ulnaris - carpi digitorum - digit minimi - pollicis (longus and brevis) - indicis	Dorsum of hand (lateral/snuff box)