The muscular system

Muscles of the face and neck Muscles of the face Muscles of the neck

Muscles of the back Muscles of the abdominal wall Functions Functions Types of joint Characteristics of a synovial joint Main synovial joints of the limbs Muscles and movements Muscles and movements Muscles and movements Muscles and movements Muscles of the pelvic floor The joints Synovial or freely movable joints

Shoulder joint Elbow joint Proximal and distal radioulnar joints rist joint !oints of the hands and fin"ers #ip joint Muscles and movements Muscles and movements Muscles and movements $nee joint %nkle joint !oints of the foot and toes

The three types of muscle tissue& their features and the nomenclature of skeletal muscles are described on pa"e '() This chapter considers the skeletal muscles not involved in the movements of the joints of the limbs* muscles of the face and neck muscles of the back muscles of the abdominal wall muscles of the pelvic floor)

Muscles of respiration are described on pa"e +,+) The muscles that move the joints are described in Chapter -.) M/SC0ES 1F T#E F%CE %23 2EC$ 4Fi") -5)-6 0earnin" outcomes %fter studyin" this section you should be able to* name the main muscles of the face and neck outline the functions of the main muscles of the face and neck)

Muscles of the face There are many muscles involved in chan"in" facial expression and with movement of the lower jaw durin" chewin" and speakin") 1nly the main muscles are described here) Except where indicated the muscles are present in pairs& one on each side) 1ccipitofrontalis 4unpaired6) This consists of a posterior muscular part over the occipital bone 4occipitalis6& an anterior part over the frontal bone 4frontalis6 and an extensive flat tendon or aponeurosis that stretches over the dome of the skull and joins the two muscular parts) 7t raises the eyebrows) 0evator palpebrae superioris) This muscle extends from the posterior part of the orbital cavity to the upper eyelid) 7t raises the eyelid) 1rbicularis oculi) This muscle surrounds the eye& eyelid and orbital cavity) 7t closes the eye and when stron"ly contracted screws up the eyes) 8uccinator) This flat muscle of the cheek draws the cheeks in towards the teeth in chewin" and in forcible expulsion of air from the mouth 4the trumpeter s muscle6) 1rbicularis oris 4unpaired6) This muscle surrounds the mouth and blends with the muscles of the cheeks) 7t closes the lips and& when stron"ly contracted& shapes the mouth for whistlin") Masseter) This is a broad muscle& extendin" from the 9y"omatic arch to the an"le of the jaw) 7n chewin" it draws the mandible up to the maxilla& closin" the jaw& and exerts considerable pressure on the food) Temporalis) This muscle covers the s:uamous part of the temporal bone) 7t passes behind the 9y"omatic arch to be inserted into the coronoid process of the mandible) 7t closes the mouth and assists with chewin") Ptery"oid) This muscle extends from the sphenoid bone to the mandible) 7t closes the mouth and pulls the lower jaw forward)

Muscles of the neck There are many muscles situated in the neck but only the two lar"est are considered here) Sternocleidomastoid) This muscle arises from the manubrium of the sternum and the clavicle and extends upwards to the mastoid process of the temporal bone) 7t assists in turnin" the head from side to side) hen the muscle on one side contracts it draws the head towards the shoulder) hen both contract at the same time they flex the cervical vertebrae or draw the sternum and clavicles upwards when the head is maintained in a fixed position& e)") in forced respiration) Trape9ius) This muscle covers the shoulder and the back of the neck) The upper attachment is to the occipital protuberance& the medial attachment is to the transverse processes of the cervical and thoracic vertebrae and the lateral attachment is to the clavicle and to the spinous and acromion processes of the scapula) 7t pulls the head backwards& s:uares the shoulders and controls the movements of the scapula when the shoulder joint is in use) M/SC0ES 1F T#E 8%C$ 4Fi") -5)+6 0earnin" outcomes %fter studyin" this section you should be able to* name the main muscles of the back outline the functions of the main muscles of the back)

There are six pairs of lar"e muscles in the back in addition to those that form the posterior abdominal wall) The arran"ement of these muscles is the same on each side of the vertebral column) They are* trape9ius teres major psoas latissimus dorsi :uadratus lumborum sacrospinalis)

;uadratus lumborum) This muscle ori"inates from the iliac crest then it passes upwards& parallel and close to the vertebral column and it is inserted into the -+th rib 4Fi") -5),6) To"ether the two muscles fix the lower rib durin" respiration and cause extension of the vertebral column 4bendin" backwards6) 7f one muscle contracts it causes lateral flexion of the lumbar re"ion of the vertebral column) Sacrospinalis 4erector spinae6) This is a "roup of muscles lyin" between the spinous and transverse processes of the vertebrae 4Fi") -5)<6) They ori"inate from the sacrum and are finally inserted into the occipital bone) Their contraction causes extension of the vertebral column) Muscles of the abdominal wall 0earnin" outcomes %fter studyin" this section you should be able to* name the main muscles of the abdominal wall

outline the functions of the main muscles of the abdominal wall)4Fi"s -5)=& -5&' and -5,6

There are six pairs of muscles that form the abdominal wall) From the surface inwards they are* rectus abdominis external obli:ue internal obli:ue transversus abdominis :uadratus lumborum psoas)

The anterior abdominal wall is divided lon"itudinally by a very stron" midline tendinous cord& the linea alba 4meanin" white cord6 which extends from the xiphoid process of the sternum to the symphysis pubis) The structure of the abdominal wall on each side of the linea alba is identical) >ectus abdominis) This is the most superficial muscle) 7t is broad and flat& ori"inatin" from the transverse part of the pubic bone then passin" upwards to be inserted into the lower ribs and the xiphoid process of the sternum) Medially the two muscles are attached to the linea alba) External obli:ue) This muscle extends from the lower ribs downwards and forward to be inserted into the iliac crest and& by an aponeurosis& to the linea alba) 7nternal obli:ue) This muscle lies deep to the external obli:ue) 7ts fibres arise from the iliac crest and by a broad band of fascia from the spinous processes of the lumbar vertebrae) The fibres pass upwards towards the midline to be inserted into the lower ribs and& by an aponeurosis& into the linea alba) The fibres are at ri"ht an"les to those of the external obli:ue) Transversus abdominis) This is the deepest muscle of the abdominal wall) The fibres arise from the iliac crest and the lumbar vertebrae and pass across the abdominal wall to be inserted into the linea alba by an aponeurosis) The fibres are at ri"ht an"les to those of the rectus abdominis) Functions The main function of the four pairs of muscles is to form the stron" muscular anterior wall of the abdominal cavity) hen the muscles contract to"ether they* compress the abdominal or"ans flex the vertebral colunm in the lumbar re"ion 4Fi") -5)<6)

Contraction of the muscles on one side only bends the trunk towards that side) Contraction of the obli:ue muscles on one side rotates the trunk) Muscles of the pelvic floor 0earnin" outcomes %fter studyin" this section you should be able to* name the main muscles of the pelvic floor outline the functions of the main muscles of the pelvic floor)

The pelvic floor is divided into two identical halves that unite alon" the midline) Each half consists of fascia and muscle) The muscles are* levator ani coccy"eus)

0evator ani) This is a broad flat muscle& formin" the anterior part of the pelvic floor) They ori"inate from the inner surface of the true pelvis and unite in the midline) To"ether they form a slin" which supports the pelvic or"ans) Coccy"eus) This is a trian"ular sheet of muscle and tendinous fibres situated behind the levator ani) They ori"inate from the medial surface of the ischium and are inserted into the sacrum and coccyx) They complete the formation of the pelvic floor which is perforated in the male by the urethra and anus& and in the female by the urethra& va"ina and anus) Functions The pelvic floor supports the or"ans of the pelvis and maintains continence& i)e) it resists raised intrapelvic pressure durin" micturition and defaecation) % joint is the site at which any two or more bones articulate or come to"ether) Some joints have no movement (fibrous), some only sli"ht movement (cartilaginous) and some are freely movable (synovial). TYPES OF JOINT Learning outcomes %fter studyin" this section you should be able to* state the characteristics of fixed and fibrous joints state the different types of synovial joints outline the movements possible at five types of synovial joints describe the structure and functions of a typical synovial joint)

Fibrous or fixed oints 4Fi") -.)-6 These immovable joints have fibrous tissue between the bones& e)") joints between the bones of the skull 4sutures6 and those between the teeth and the maxilla and mandible) !artilaginous or slightly mo"able oints 4Fi") -.)+6 There is a pad of fibrocartilage between the ends of the bones that form the joint which allows for very sli"ht movement where the pad of cartila"e is compressed) Examples include the symphysis pubis and the joints between the vertebral bodies) Syno"ial or freely mo"able oints Synovial joints have characteristic features that enable a wide ran"e of movements 4Table -.)-6) They are classified accordin" to the ran"e of movement possible or to the shape of the articulatin" parts of the bones involved) Ball and socket. The head or ball of one bone articulates with a socket of another

and the shape of the bones allows for a wide ran"e of movement) Those possible are flexion& extension& adduction& abduction& rotation and circumduction) Examples are the shoulder and hip) Hinge joints. These allow the movements of flexion and extension only) They are the elbow& knee& ankle& the joints between the atlas and the occipital bone& and the interphalan"eal joints of the fin"ers and toes) Gliding joints. The articular surfaces "lide over each other& e)") sternoclavicular joints& acromioclavicular joints and joints between the carpal bones and those between the tarsal bones) Pivot joints. Movement is round one axis 4rotation6& e)") proximal and distal radioulnar joints and the joint between the atlas and the odontoid process of the axis) Condyloid and saddle joints. Movements take place round two axes& permittin" flexion& extension& abduction& adduction and circumduction& e)") the wrist& temporomandibular& metacarpophalan"eal and metatarsophalan"eal joints) Characteristics of a synovial joint 4Fi") -.)=6 %ll synovial joints have certain characteristics in common) #rticular or hyaline cartilage The parts of the bones which are in contact are always covered with hyaline cartila"e) 7t provides a smooth articular surface and is stron" enou"h to absorb compression forces and bear the wei"ht of the body) The cartila"e linin"& which is up to 7 mm thick in youn" people& becomes thinner and less compressible with a"e) This leads to increasin" stress on other structures in the joint) Cartila"e has no blood supply and receives its nourishment from synovial fluid) !a$sule or ca$sular ligament The joint is surrounded and enclosed by a sleeve of fibrous tissue which holds the bones to"ether) 7t is sufficiently loose to allow freedom of movement but stron" enou"h to protect it from injury) Syno"ial membrane This is composed of epithelial cells and is found* linin" the capsule coverin" those parts of the bones within the joint not covered by articular cartila"e coverin" all intracapsular structures that do not bear wei"ht)

Syno"ial fluid% This is a thick sticky fluid& of e""?white consistency& secreted by synovial membranes into the synovial cavity, and it* provides nutrients for the structures within the joint cavity contains pha"ocytes& which remove microbes and cellular debris acts as a lubricant maintains joint stability prevents the ends of the bones from bein" separated& as does a little water between two "lass surfaces)

0ittle sacs of synovial fluid or bursae are present in some joints& e)") the knee) They act as cushions to prevent friction between a bone and a li"ament or tendon& or skin where a bone in a joint is near the surface)

Other intraca$sular structures Some joints have structures within the capsule& but outside the synovial membrane& which assist in maintenance of stability& e)") fat pads and menisci in the knee joint) hen these structures do not bear wei"ht they are covered by synovial membrane) Extraca$sular structures Liga ents that blend with the capsule provide additional stability at most joints) !uscles or their tendons also provide stability and stretch across the joints they move) the muscle contracts it shortens& pullin" one bone towards the other) hen

Ner"e and blood su$$ly 2erves and blood vessels crossin" a joint usually supply the capsule and the muscles that move it) &#IN SYNO'I#L JOINTS OF T(E LI&)S 0earnin" outcome %fter studyin" this section you should be able to* describe the structure and movements of the followin" synovial joints* shoulder& elbow& wrist& hip& knee& ankle)

7ndividual synovial joints have the characteristics described above so only their distinctive features are included in this section) Shoulder oint 4Fi") -.)'6 This ball and socket joint is formed by the "lenoid cavity of the scapula and the head of the humerus) The capsular li"ament is very loose inferiorly to allow for the free movement normally possible at this joint) The "lenoid cavity is deepened by a rim of fibrocartila"e& the glenoidal labru , which provides additional stability without limitin" movement) The tendon of the lon" head of the bice"s uscle, lyin" in the intertubercular 4bicipital6 "roove of the humerus& extends throu"h the joint cavity and is attached to the upper rim of the "lenoid cavity) 7t has an important stabilisin" effect on the joint) Synovial membrane forms a sleeve round the part of the tendon of the lon" head of the biceps muscles within the capsular li"ament and covers the "lenoidal labrum) Extracapsular structures consist of* the coraco#u eral liga ent, extendin" from the coracoid process of the scapula to the humerus the gleno#u eral liga ents, which blend with and stren"then the capsule the transverse #u eral liga ent, retainin" the biceps tendon in the intertubercular "roove)

The stability of the joint may be reduced if these structures& to"ether with the tendon of the biceps muscle& are stretched by repeated dislocations of the joint) Muscles and movements &uscles 4Fi") -.),6 !oracobrachialis muscle% This lies on the upper medial aspect of the arm) 7t arises from the coracoid process of the scapula& stretches across in front of the shoulder joint and is inserted into the middle third of the humerus) 7t flexes the shoulder joint)

*eltoid muscle% These muscle fibres ori"inate from the clavicle& acromion process and spine of scapula and radiate over the shoulder joint to be inserted into the deltoid tuberosity of the humerus) 7t forms the fleshy and rounded contour of the shoulder) The anterior fibres cause flexion& the middle or main part& abduction and the posterior fibres extend the shoulder joint) Pectoralis ma or% This lies on the anterior thoracic wall) The fibres ori"inate from the middle third of the clavicle and from the sternum and are inserted into the lip of the intertubercular "roove of the humerus) 7t draws the arm forward and towards the body& i)e) flexes and adducts) Latissimus dorsi% This arises from the posterior part of the iliac crest and the spinous processes of the lumbar and lower thoracic vertebrae) 7t passes upwards across the back then under the arm to be inserted into the bicipital "roove of the humerus) 7t adducts& medially rotates and extends the arm) Teres ma or% This ori"inates from the inferior an"le of the scapula and is inserted into the humerus just below the shoulder joint) 7t extends& adducts and medially rotates the arm) &o"ements $le%ion& coracobrachialis& anterior fibres of deltoid and pectoralis major) '%tension& teres major& latissimus dorsi and posterior fibres of deltoid) (bduction& deltoid) (dduction& combined action of flexors and extensors) Circu duction& flexors& extensors& abductors and adductors actin" in series) !edial rotation& pectoralis major& latissimus dorsi& teres major and anterior fibres of deltoid) Lateral rotation& posterior fibres of deltoid) Elbo+ oint 4Fi") -.)<6 This #inge joint is formed by the trochlea and the capitulum of the humerus and the trochlear notch of the ulna and the head of the radius) Extracapsular structures consist of anterior& posterior& medial and lateral stren"thenin" li"aments) Muscles and movements &uscles 4Fi") -.),6 )ice$s muscle% This lies on the anterior aspect of the upper arm) %t its proximal end it is divided into two parts 4heads6 each of which has its own tendon) The short head rises from the coracoid process of the scapula and passes in front of the shoulder joint to the arm) The lon" head ori"inates from the rim of the "lenoid cavity and its tendon passes throu"h the joint cavity and the bicipital "roove of the humerus to the arm) 7t is retained in the bicipital "roove by a transverse li"ament which stretches across the "roove) The distal tendon crosses the elbow joint and is inserted into the radial tuberosity) 7t helps to stabilise and flex the shoulder joint and at the elbow joint it assists with flexion and supination) )rachialis muscle% This lies on the anterior aspect of the upper arm deep to the biceps) 7t ori"inates from the shaft of the humerus& extends across the elbow joint and is inserted into the ulna just distal to the joint capsule) 7t is the main flexor of the elbow joint) Trice$s muscle% This lies on the posterior aspect of the humerus) 7t arises from three heads& one from the scapula and two from the posterior surface of the humerus) The insertion is by a common tendon to the olecranon process of the ulna) 7t helps to stabilise the shoulder joint& assists in adduction of the arm and extends the elbow joint)

&o"ements $le%ion& biceps and brachialis) '%tension& triceps) Proximal and distal radioulnar oints The "ro%i al radioulnar joint, formed by the rim of the head of the radius rotatin" in the radial notch of the ulna& is in the same capsule as the elbow joint) The annular liga ent is a stron" extracapsular li"ament which encircles) the head of the radius and keeps it in contact with the radial notch of the ulna 4Fi") -.)<86) The distal radioulnar joint is a pivot joint between the distal end of the radius and the head of the ulna 4Fi") -.).6) Muscles and movements &uscles 4Fi") -.),6 Pronator teres) This lies obli:uely across the upper third of the front of the forearm) 7t arises from the medial epicondyle of the humerus and the coronoid process of the ulna and passes obli:uely across the forearm to be inserted into the lateral surface of the shaft of the radius) 7t rotates the radioulnar joints& chan"in" the hand from the anatomical to the writin" position& i)e) pronation) Su$inator muscle) This lies obli:uely across the posterior and lateral aspects of the forearm) 7ts fibres arise from the lateral epicondyle of the humerus and the upper part of the ulna and are inserted into the lateral surface of the upper third of the radius) 7t rotates the radioulnar joints& chan"in" the hand from the writin" to the anatomical position& i)e) supination) 7t lies deep to the muscles shown in Fi"ure -.),) Movements Pronation& pronator teres) )u"ination& supinator and biceps) ,rist oint 4Fi") -.).6 This is a condyloid joint between the distal end of the radius and the proximal ends of the scaphoid& lunate and tri:uetral) % disc of white fibrocartila"e separates the ulna from the joint cavity and articulates with the carpal bones) 7t also separates the inferior radioulnar joint from the wrist joint) Extracapsular structures consist of medial and lateral li"aments and anterior and posterior radiocarpal li"aments) Muscles and movements Muscles 4Fi") -.),6 Flexor car$i radialis) This lies on the anterior surface of the forearm) 7t ori"inates from the medial epicondyle of the humerus and is inserted into the second and third metacarpal bones) 7t flexes the wrist joint& and when actin" with the extensor carpi radialis& abducts the joint) Flexor car$i ulnaris) This lies on the medial aspect of the forearm) 7t ori"inates from the medial epicondyle of the humerus and the upper parts of the ulna and is inserted into the pisiform& the hamate and the fifth metacarpal bones) 7t flexes the wrist& and when actin" with the extensor carpi ulnaris& adducts the joint)

Extensor car$i radialis longus and bre"is) These lie on the posterior aspect of the forearm) The fibres ori"inate from the lateral epicondyle of the humerus and are inserted by a lon" tendon into the second and third metacarpal bones) They extend and abduct the wrist) Extensor car$i ulnaris) This lies on the posterior surface of the forearm) 7t ori"inates from the lateral epicondyle of the humerus and is inserted into the fifth metacarpal bone) 7t extends and adducts the wrist) &o"ements $le%ion& flexor carpi radialis and the flexor carpi ulnaris) '%tension& extensors carpi radialis 4lon"us and brevis6 and the extensor carpi ulnaris) (bduction& flexor and extensors carpi radialis) (dduction& flexor and extensor carpi ulnaris) Joints of the hands and fingers There are synovial joints between the carpal bones& between the carpal and metacarpal bones& between the metacarpal bones and proximal phalan"es and between the phalan"es) The powerful movements that occur at these joints are produced by muscles in the forearm which have tendons extendin" into the hand) Many of the finer movements of the fin"ers are produced by numerous small muscles in the hand) *#e fle%or retinaculu is a stron" fibrous band that stretches across the front of the carpal bones& enclosin" their concavity and formin" the car"al tunnel. The tendons of flexor muscles of the wrist joint and the fin"ers and the median nerve pass throu"h the carpal tunnel& the retinaculum holdin" them close to the bones) Synovial membrane forms sleeves around these tendons in the carpal tunnel and extends some way into the palm of the hand) Synovial sheaths also enclose the tendons on the flexor surfaces of the fin"ers) Synovial fluid prevents friction that mi"ht dama"e the tendons as they move over the bones 4Fi") -.)56) *#e e%tensor retinaculu is a stron" fibrous band that extends across the back of the wrist) Tendons of muscles that extend the wrist and fin"er joints are encased in synovial membrane under the retinaculum) The synovial sheaths are less extensive than on the flexor aspect) The synovial fluid secreted prevents friction) (i$ oint 4Fi") -.)@6 This ball and socket joint is formed by the cup?shaped acetabulum of the innominate bone and the almost spherical head of the femur) The capsular li"ament includes most of the neck of the femur) The cavity is deepened by the acetabular labru , a rin" of fibrocartila"e attached to the rim of the acetabulum) This adds stability to the joint without limitin" its ran"e of movement) The li"ament of the head of the femur extends from the shallow depression in the middle of the head of the femur to the acetabulum) 7t conveys a blood vessel to the head of the femur) Synovial membrane covers both sides of the acetabular labrum and forms a sleeve around the li"ament of the head of the femur) There are three important li"aments that surround and stren"then the capsule) They are the iliofe oral, isc#iofe oral and "ubofe oral liga ents. Muscles and movements &uscles 4Fi"s -.)-( and -.)--6

Psoas muscle% This arises from the transverse processes and bodies of the lumbar vertebrae) 7t passes across the flat part of the ilium and behind the in"uinal li"ament to be inserted into the femur) To"ether with the iliacus it flexes the hip joint 4Fi") -.)-(6) Iliacus muscle% This lies in the iliac fossa of the innominate bone) 7t ori"inates from the iliac crest& passes over the iliac fossa and joins the tendon of the psoas muscle to be inserted into the lesser trochanter of the femur) The combined action of iliacus and psoas flexes the hip joint) -uadrice$s femoris% This is a "roup of four muscles lyin" on the front and sides of the thi"h) They are the rectus fe oris and three vasti. The rectus femoris ori"inates from the ilium and the three vasti from the upper end of the femur) To"ether they pass over the front of the knee joint to be inserted into the tibia by the patellar tendon) 1nly the rectus femoris flexes the hip joint) To"ether the "roup acts as a very stron" extensor of the knee joint) .luteal muscles% These consist of the gluteus a%i us, edius and ini us which to"ether form the fleshy part of the buttock) They ori"inate from the ilium and sacrum and are inserted into the femur) They cause extension& abduction and medial rotation at the hip joint) Sartorius% This is the lon"est muscle in the body and crosses both the hip and knee joints) 7t ori"inates from the anterior superior iliac spine and passes obli:uely across the hip joint& thi"h and knee joint to be inserted into the medial surface of the upper part of the tibia) 7t is associated with flexion and abduction at the hip joint and flexion at the knee) #dductor grou$% This lies on the medial aspect of the thi"h) They ori"inate from the pubic bone and are inserted into the linea aspera of the femur) They adduct and medially rotate the thi"h) &o"ements $le%ion& psoas& iliacus& rectus femoris and sartorius) '%tension& "luteus maximus and the hamstrin"s) (bduction& "luteus medius and minimus& sartorius and others) (dduction& adductor "roup) Lateral rotation& mainly "luteal muscles and adductor "roup) !edial rotation& "luteus medius and minimus and others) /nee oint 4Fi") -.)-+6 This is the lar"est and most complex joint) 7t is a hin"e joint formed by the condyles of the femur& the condyles of the tibia and the posterior surface of the patella) The anterior part of the capsule consists of the tendon of the :uadriceps femoris muscle which also supports the patella) 7ntracapsular structures include two cruciate liga ents that cross each other& extendin" from the intercondylar notc# of the femur to the intercondylar e inence of the tibia) They help to stabilise the joint) )e ilunar cartilages or enisci are incomplete discs of white fibrocartila"e lyin" on top of the articular condyles of the tibia) They are wed"e?shaped& bein" thicker at their outer ed"es) They help to stabilise the joint by preventin" lateral displacement of the bones) 8ursae and pads of fat are numerous) They prevent friction between a bone and a li"ament or tendon and between the skin and the patella) Synovial membrane covers the cruciate li"aments and the pads of fat) The menisci are not covered with synovial membrane because they are wei"ht bearin") The most important stren"thenin" li"aments are the edial and lateral liga ents. Muscles and movements

Possible movements at this joint are flexion& extension and a rotatory movement which locks the joint when it is fully extended) hen the joint is locked& balance is maintained with less muscular effort than when it is flexed) &uscles 4Fi") -.)--6 (amstring muscles% These lie on the posterior aspect of the thi"h) They ori"inate from the ischium and are inserted into the upper end of the tibia) They are bice"s fe oris, se i e branosus and se itendinosus uscles. They flex the knee joint) .astrocnemius% This forms the bulk of the calf of the le") 7t arises by two heads& one from each condyle of the femur& and passes down behind the tibia to be inserted into the calcaneus by the calcanean tendon ((c#illes tendon). 7t crosses both knee and ankle joints& causin" flexion at the knee and plantarflexion at the ankle) -uadrice$s femoris 4described above6) This extends the knee joint) &o"ements $le%ion 4bendin" backwards6* "astrocnemius and hamstrin"s) '%tension 4strai"htenin"6* :uadriceps femoris muscle) #n0le oint 4Fi") -.)-=6 This #inge joint is formed by the distal end of the tibia and its malleolus 4medial malleolus6& the distal end of the fibula 4lateral malleolus6 and the talus) There are four important li"aments stren"thenin" this joint) They are the deltoid and anterior& posterior& medial and lateral li"aments) Muscles and movements &uscles 4Fi") -.)--6 #nterior tibialis muscle% This ori"inates from the upper end of the tibia& lies on the anterior surface of the le" and is inserted into the middle cuneiform bone by a lon" tendon) 7t is associated with dorsiflexion of the foot) Soleus% This is one of the main muscles of the calf of the le"& lyin" immediately deep to the "astrocnemius) 7t ori"inates from the heads and upper parts of the fibula and the tibia) 7ts tendon joins that of the "astrocnemius so that they have a common insertion into the calcaneus by the calcanean 4%chilles6 tendon) 7t causes plantarflexion at the ankle and helps to stabilise the joint when standin") .astrocnemius% This 4described above6 is a powerful plantarflexor) &o"ements $le%ion (dorsifle%ion)& anterior tibialis assisted by the muscles which extend the toes) '%tension ("lantarfie%ion)& "astrocnemius and soleus assisted by the muscles which flex the toes) The movements of inversion and eversion occur between the tarsal bones and not at the ankle joint) Joints of the foot and toes There are a number of synovial joints between the tarsal bones& between the tarsal and metatarsal bones& between the metatarsals and proximal phalan"es and between the phalan"es) Movements are

produced by muscles in the le" with lon" tendons which cross the ankle joint& and by muscles of the foot) The tendons crossin" the ankle joint are encased in synovial sheaths and are held close to the bones by stron" transverse li"aments) They move smoothly within their sheaths as the joints move) 7n addition to movin" the joints of the foot these muscles support the arches of the foot and help to maintain body balance)