Muscles OAIN (OSCE).docx

**[Shoulder & ]** **Anterior Deltoid** Origin: Lateral third of the clavicle. Insertion: Deltoid tuberosity of the humerus Action: Flexes and medially rotates the arm Nerve Supply: Axillary nerve (C5, C6). Trigger Point: Pain can be referred to the lateral shoulder and upper arm. **Medial Del...

**[Shoulder & ]** **Anterior Deltoid** Origin: Lateral third of the clavicle. Insertion: Deltoid tuberosity of the humerus Action: Flexes and medially rotates the arm Nerve Supply: Axillary nerve (C5, C6). Trigger Point: Pain can be referred to the lateral shoulder and upper arm. **Medial Deltoid** Origin: Acromion of the scapula. Insertion: Deltoid tuberosity of the humerus Action: : Abducts the arm Nerve Supply: Axillary nerve (C5, C6). Trigger Point: Pain can be referred to the lateral shoulder and upper arm. **Posterior Deltoid** Origin: Spine of the Scapula Insertion: Deltoid tuberosity of the humerus Action: Extends and laterally rotates the arm Nerve Supply: Axillary nerve (C5, C6). Trigger Point: Pain can be referred to the lateral shoulder and upper arm. **Teres Major** **Origin**: Posterior aspect of the inferior angle of the scapula. **Insertion**: Medial lip of the intertubercular sulcus of the humerus. **Main Action**: Adducts and medially rotates the humerus. **Nerve Supply**: Lower subscapular nerve (C5, C6). **Trigger Point Referral Pain**: **Teres Minor** **Origin**: Lateral border of the scapula. **Insertion**: Greater tubercle of the humerus. **Main Action**: Laterally rotates the arm. Assists in adduction of the arm. **Nerve Supply**: Axillary nerve (C5, C6). **Trigger Point Referral Pain**: Pain can be referred to the posterior shoulder and down the lateral arm. **Subscapularis** **Origin**: Subscapular fossa of the scapula. **Insertion**: Lesser tubercle of the humerus. **Main Action**: Medially rotates the arm. Helps to hold the head of the humerus in the glenoid cavity. **Nerve Supply**: Upper and lower subscapular nerves (C5, C6, C7). **Trigger Point Referral Pain**: Pain can be referred to the posterior shoulder, scapula, and down the back of the arm. **Supraspinatus** **Origin**: Supraspinous fossa of the scapula. **Insertion**: Greater tubercle of the humerus. **Main Action**: Abducts the arm (first 15 degrees). Stabilizes the shoulder joint. **Nerve Supply**: Suprascapular nerve (C5, C6). **Trigger Point Referral Pain**: Pain can be referred to the lateral shoulder and down the arm. **Infraspinatus** **Origin**: Infraspinous fossa of the scapula. **Insertion**: Greater tubercle of the humerus. **Main Action**: Laterally rotates the arm. Stabilizes the shoulder joint. **Nerve Supply**: Suprascapular nerve (C5, C6). **Trigger Point Referral Pain**: Pain can be referred to the anterior shoulder and down the lateral arm. **[Back Muscles]** **Trapezius** **Origin**: External occipital protuberance, nuchal ligament, and spinous processes of C7-T12. **Insertion**: Lateral third of the clavicle, acromion, and spine of the scapula. **Main Action**: Elevates, retracts, and rotates the scapula. Upper fibers: Elevate the scapula. Middle fibers: Retract the scapula. Lower fibers: Depress the scapula. **Nerve Supply**: Accessory nerve (CN XI) and cervical spinal nerves (C3 and C4). **Trigger Point Referral Pain**: Pain is often felt in the neck, shoulders, and can refer to the temple and jaw area. **Latissimus Dorsi** **Origin**: Spinous processes of T7-T12, thoracolumbar fascia, iliac crest, and inferior three or four ribs. **Insertion**: Floor of the intertubercular groove of the humerus. **Main Action**: Extends, adducts, and medially rotates the humerus. Raises the body towards arms during climbing. **Nerve Supply**: Thoracodorsal nerve (C6-C8). **Trigger Point Referral Pain**: - **Rhomboid Major** **Origin**: Spinous processes of T2-T5. **Insertion**: Medial border of the scapula from the spine to the inferior angle. **Main Action**: Retracts the scapula. Rotates the scapula to depress the glenoid cavity. **Nerve Supply**: Dorsal scapular nerve (C4, C5). **Trigger Point Referral Pain**: Pain can be referred to the medial border of the scapula and upper back. **Rhomboid Minor** **Origin**: Spinous processes of C7-T1. **Insertion**: Medial border of the scapula at the level of the spine. **Main Action**: Retracts the scapula. Rotates the scapula to depress the glenoid cavity. **Nerve Supply**: Dorsal scapular nerve (C4, C5). **Trigger Point Referral Pain**: Pain can be referred to the medial border of the scapula and upper back. **Levator Scapulae** **Origin**: Transverse processes of C1-C4. **Insertion**: Medial border of the scapula, between the superior angle and the spine. **Main Action**: Elevates the scapula. Rotates the scapula to depress the glenoid cavity. **Nerve Supply**: Dorsal scapular nerve (C5) and cervical nerves (C3, C4). **Trigger Point Referral Pain**: Pain can be referred to the medial border of the scapula, neck, and sometimes to the shoulder. **Pectoralis Minor** **Origin**: Anterior surfaces of ribs 3-5. **Insertion**: Coracoid process of the scapula. **Main Action**: Stabilizes the scapula by drawing it inferiorly and anteriorly against the thoracic wall. **Nerve Supply**: Medial pectoral nerve (C8, T1). **Trigger Point Referral Pain**: Pain can be referred to the anterior shoulder and chest, and sometimes down the inner arm. **Pectoralis Major** **Origin**: Clavicular head: Medial half of the clavicle. Sternocostal head: Sternum, upper six costal cartilages, and the aponeurosis of the external oblique muscle. **Insertion**: Lateral lip of the bicipital groove of the humerus. **Main Action**: Adducts and medially rotates the humerus. Clavicular head: Flexes the humerus. Sternocostal head: Extends the humerus from a flexed position. **Nerve Supply**: Medial and lateral pectoral nerves (C5-C8, T1). **Trigger Point Referral Pain**: Pain is typically felt in the anterior shoulder, down the inner arm to the elbow, and can sometimes refer to the chest. **Biceps Brachii** **Origin**: Short head: Coracoid process of the scapula. Long head: Supraglenoid tubercle of the scapula. **Insertion**: Radial tuberosity and bicipital aponeurosis. **Main Action**: Flexes the elbow and supinates the forearm. Flexes the shoulder (long head). **Nerve Supply**: Musculocutaneous nerve (C5, C6). **Trigger Point Referral Pain**: Pain is typically felt in the anterior shoulder and down the front of the arm, sometimes extending to the **[Forearm Group]** ### 1. **Brachialis** - **Origin**: - Distal half of the anterior surface of the humerus. - **Insertion**: - Coronoid process and the tuberosity of the ulna. - **Main Action**: - Flexes the elbow. - **Nerve Supply**: - Musculocutaneous nerve (C5, C6) and radial nerve (C7). - **Trigger Point Referral Pain**: - Pain can be referred to the anterior elbow and down to the base of the thumb. ### 2. **Brachioradialis** - **Origin**: - Lateral supracondylar ridge of the humerus. - **Insertion**: - Styloid process of the radius. - **Main Action**: - Flexes the elbow, especially in mid-pronation (thumbs-up) position. - **Nerve Supply**: - Radial nerve (C5, C6, C7). - **Trigger Point Referral Pain**: - Pain can be referred to the lateral side of the elbow and down the forearm to the thumb. ### 3. Extensor Carpi Radialis Longus - **Origin**: - Lateral supracondylar ridge of the humerus. - **Insertion**: - Base of the second metacarpal. - **Main Action**: - Extends and abducts the wrist. - **Nerve Supply**: - Radial nerve (C6, C7). - **Trigger Point Referral Pain**: - Pain can be referred to the lateral elbow and forearm - **Origin**: - Lateral epicondyle of the humerus. - **Insertion**: - Base of the third metacarpal. - **Main Action**: - Extends and abducts the wrist. - **Nerve Supply**: - Radial nerve (C6, C7). - **Trigger Point Referral Pain**: - Pain can be referred to the lateral elbow and forearm. #### Extensor Digitorum - **Origin**: - Lateral epicondyle of the humerus. - **Insertion**: - Extensor expansions of the medial four digits. - **Main Action**: - Extends the fingers and the wrist. - **Nerve Supply**: - Posterior interosseous nerve (C7, C8). - **Trigger Point Referral Pain**: - Pain can be referred to the back of the hand and forearm. #### Extensor Digiti Minimi - **Origin**: - Lateral epicondyle of the humerus. - **Insertion**: - Extensor expansion of the fifth digit. - **Main Action**: - Extends the little finger. - **Nerve Supply**: - Posterior interosseous nerve (C7, C8). - **Trigger Point Referral Pain**: - Pain can be referred to the back of the hand and forearm. #### Extensor Carpi Ulnaris - **Origin**: - Lateral epicondyle of the humerus and posterior border of the ulna. - **Insertion**: - Base of the fifth metacarpal. - **Main Action**: - Extends and adducts the wrist. - **Nerve Supply**: - Posterior interosseous nerve (C7, C8). - **Trigger Point Referral Pain**: - Pain can be referred to the ulnar side of the forearm and wrist. #### Extensor Indicis - **Origin**: - Posterior surface of the ulna and interosseous membrane. - **Insertion**: - Extensor expansion of the second digit. - **Main Action**: - Extends the index finger. - **Nerve Supply**: - Posterior interosseous nerve (C7, C8). - **Trigger Point Referral Pain**: - Pain can be referred to the back of the hand and forearm. ### 4. **Forearm Flexors** #### Flexor Carpi Radialis - **Origin**: - Medial epicondyle of the humerus. - **Insertion**: - Base of the second and third metacarpals. - **Main Action**: - Flexes and abducts the wrist. - **Nerve Supply**: - Median nerve (C6, C7). - **Trigger Point Referral Pain**: - Pain can be referred to the palmar side of the wrist and forearm. #### Flexor Carpi Ulnaris - **Origin**: - Humeral head: Medial epicondyle of the humerus. - Ulnar head: Olecranon and posterior border of the ulna. - **Insertion**: - Pisiform, hook of the hamate, and base of the fifth metacarpal. - **Main Action**: - Flexes and adducts the wrist. - **Nerve Supply**: - Ulnar nerve (C7, C8). - **Trigger Point Referral Pain**: - Pain can be referred to the ulnar side of the wrist and forearm. #### Flexor Digitorum Superficialis - **Origin**: - Humeroulnar head: Medial epicondyle of the humerus and coronoid process of the ulna. - Radial head: Anterior surface of the radius. - **Insertion**: - Middle phalanges of the medial four digits. - **Main Action**: - Flexes the middle phalanges at the proximal interphalangeal joints. - **Nerve Supply**: - Median nerve (C7, C8, T1). - **Trigger Point Referral Pain**: - Pain can be referred to the palmar side of the wrist and fingers. #### Flexor Digitorum Profundus - **Origin**: - Anterior and medial surfaces of the ulna and interosseous membrane. - **Insertion**: - Distal phalanges of the medial four digits. - **Main Action**: - Flexes the distal phalanges at the distal interphalangeal joints. - **Nerve Supply**: - Medial part: Ulnar nerve (C8, T1). - Lateral part: Anterior interosseous branch of the median nerve (C8, T1). - **Trigger Point Referral Pain**: - Pain can be referred to the palmar side of the wrist and fingers. #### Flexor Pollicis Longus - **Origin**: - Anterior surface of the radius and interosseous membrane. - **Insertion**: - Base of the distal phalanx of the thumb. - **Main Action**: - Flexes the thumb. - **Nerve Supply**: - Anterior interosseous branch of the median nerve (C8, T1). - **Trigger Point Referral Pain**: - Pain can be referred to the thumb and thenar eminence. #### Palmaris Longus - **Origin**: - Medial epicondyle of the humerus. - **Insertion**: - Palmar aponeurosis and flexor retinaculum. - **Main Action**: - Flexes the wrist and tenses the palmar aponeurosis. - **Nerve Supply**: - Median nerve (C7, C8). - **Trigger Point Referral Pain**: - Pain can be referred to the palmar side of the wrist and forearm. ### 5. **Pronator Teres** - **Origin**: - Humeral head: Medial epicondyle of the humerus. - Ulnar head: Coronoid process of the ulna. - **Insertion**: - Lateral surface of the radius. - **Main Action**: - Pronates the forearm and assists in flexing the elbow. - **Nerve Supply**: - Median nerve (C6, C7). - **Trigger Point Referral Pain**: - Pain can be referred to the forearm and wrist, and sometimes to the thumb and index finger. This list provides a detailed overview of the muscles in the forearm and related areas, including their origins, insertions, main actions, nerve supplies, and trigger point referral pain. If you need more specific details or additional muscles, feel free to ask! **[Spine & Thorax]** ### 1. **Erector Spinae Group** The Erector Spinae group consists of three main muscle columns: Iliocostalis, Longissimus, and Spinalis. #### Iliocostalis - **Origin**: - Iliac crest, sacrum, lumbar vertebrae, and ribs. - **Insertion**: - Ribs and transverse processes of cervical vertebrae. - **Main Action**: - Extends and laterally flexes the vertebral column. - **Nerve Supply**: - Dorsal rami of spinal nerves. - **Trigger Point Referral Pain**: - Pain can be referred along the back, typically in the lower thoracic and lumbar regions. #### Longissimus - **Origin**: - Transverse processes of lumbar, thoracic, and cervical vertebrae. - **Insertion**: - Transverse processes of thoracic and cervical vertebrae, ribs, and mastoid process of the temporal bone. - **Main Action**: - Extends and laterally flexes the vertebral column, extends and rotates the head. - **Nerve Supply**: - Dorsal rami of spinal nerves. - **Trigger Point Referral Pain**: - Pain can be referred along the spine, typically in the thoracic region and up to the neck. #### Spinalis - **Origin**: - Spinous processes of upper lumbar and lower thoracic vertebrae. - **Insertion**: - Spinous processes of upper thoracic and cervical vertebrae. - **Main Action**: - Extends the vertebral column. - **Nerve Supply**: - Dorsal rami of spinal nerves. - **Trigger Point Referral Pain**: - Pain can be referred along the midline of the back, typically in the thoracic region. ### 2. **Splenius Capitis** - **Origin**: - Nuchal ligament and spinous processes of C7-T3 or T4. - **Insertion**: - Mastoid process of the temporal bone and the lateral third of the superior nuchal line of the occipital bone. - **Main Action**: - Extends, rotates, and laterally flexes the head. - **Nerve Supply**: - Dorsal rami of middle cervical spinal nerves. - **Trigger Point Referral Pain**: - Pain can be referred to the top of the head, around the eyes, and behind the ears. ### 3. **Splenius Cervicis** - **Origin**: - Spinous processes of T3-T6. - **Insertion**: - Transverse processes of C1-C3. - **Main Action**: - Extends, rotates, and laterally flexes the neck. - **Nerve Supply**: - Dorsal rami of lower cervical spinal nerves. - **Trigger Point Referral Pain**: - Pain can be referred to the back of the neck and upper shoulders. ### 4. **Quadratus Lumborum** - **Origin**: - Iliac crest and iliolumbar ligament. - **Insertion**: - Inferior border of the 12th rib and transverse processes of L1-L4. - **Main Action**: - Lateral flexion of the vertebral column, extends the lumbar spine, and fixes the 12th rib during forced expiration. - **Nerve Supply**: - Ventral rami of T12 and L1-L4 spinal nerves. - **Trigger Point Referral Pain**: - Pain can be referred to the lower back, hip, and sometimes the buttocks. ### 5. **Rectus Abdominis** - **Origin**: - Pubic crest and symphysis. - **Insertion**: - Xiphoid process and costal cartilages of ribs 5-7. - **Main Action**: - Flexes the lumbar spine and compresses the abdominal viscera. - **Nerve Supply**: - Lower six thoracic nerves (T7-T12). - **Trigger Point Referral Pain**: - Pain can be referred to the lower back and upper abdomen, sometimes mimicking visceral pain. **[Head & Neck]** ### 1. **Sternocleidomastoid** - **Origin**: - Sternal head: Manubrium of the sternum. - Clavicular head: Medial third of the clavicle. - **Insertion**: - Mastoid process of the temporal bone and lateral half of the superior nuchal line of the occipital bone. - **Main Action**: - Unilaterally: Flexes the neck and rotates the head to the opposite side. - Bilaterally: Flexes the neck and extends the head. - **Nerve Supply**: - Accessory nerve (CN XI) and branches of cervical plexus (C2, C3). - **Trigger Point Referral Pain**: - Pain can be referred to the forehead, around the eyes, the jaw, the cheek, and the back of the head. ### 2. **Scalene Muscles** #### Anterior Scalene - **Origin**: - Transverse processes of C3-C6. - **Insertion**: - First rib. - **Main Action**: - Elevates the first rib, flexes and laterally bends the neck. - **Nerve Supply**: - Ventral rami of cervical spinal nerves (C4-C6). - **Trigger Point Referral Pain**: - Pain can be referred to the upper chest, shoulder, and down the arm to the thumb. #### Middle Scalene - **Origin**: - Transverse processes of C2-C7. - **Insertion**: - First rib. - **Main Action**: - Elevates the first rib, flexes and laterally bends the neck. - **Nerve Supply**: - Ventral rami of cervical spinal nerves (C3-C8). - **Trigger Point Referral Pain**: - Pain can be referred to the upper chest, shoulder, and down the arm to the thumb. #### Posterior Scalene - **Origin**: - Transverse processes of C4-C6. - **Insertion**: - Second rib. - **Main Action**: - Elevates the second rib, flexes and laterally bends the neck. - **Nerve Supply**: - Ventral rami of cervical spinal nerves (C6-C8). - **Trigger Point Referral Pain**: - Pain can be referred to the upper back, shoulder, and down the arm to the middle finger. ### 3. **Masseter** - **Origin**: - Superficial part: Zygomatic process of the maxilla and lower border of the zygomatic arch. - Deep part: Posterior third of the zygomatic arch. - **Insertion**: - Angle and ramus of the mandible. - **Main Action**: - Elevates the mandible (closes the jaw). - **Nerve Supply**: - Mandibular nerve (V3 branch of the trigeminal nerve, CN V). - **Trigger Point Referral Pain**: - Pain can be referred to the jaw, teeth, above the eye, and ear. ### 4. **Temporalis** - **Origin**: - Temporal fossa and temporal fascia. - **Insertion**: - Coronoid process and anterior border of the ramus of the mandible. - **Main Action**: - Elevates and retracts the mandible (closes the jaw). - **Nerve Supply**: - Mandibular nerve (V3 branch of the trigeminal nerve, CN V). - **Trigger Point Referral Pain**: - Pain can be referred to the temples, teeth, eyebrow area, and the side of the head. This list provides detailed information about the origin, insertion, main action, nerve supply, and trigger point referral pain for each of the specified muscles. If you need more information or additional muscles, feel free to ask! **[Upper Leg]** ### **Quadriceps Femoris Group** #### 1. Rectus Femoris - **Origin**: - Anterior inferior iliac spine (AIIS) and ilium above the acetabulum. - **Insertion**: - Patella and tibial tuberosity via the patellar ligament. - **Main Action**: - Extends the knee and flexes the hip. - **Nerve Supply**: - Femoral nerve (L2, L3, L4). - **Trigger Point Referral Pain**: - Pain can be referred to the front of the thigh and knee. #### 2. Vastus Lateralis - **Origin**: - Greater trochanter and lateral lip of the linea aspera. - **Insertion**: - Patella and tibial tuberosity via the patellar ligament. - **Main Action**: - Extends the knee. - **Nerve Supply**: - Femoral nerve (L2, L3, L4). - **Trigger Point Referral Pain**: - Pain can be referred to the lateral thigh and knee. #### 3. Vastus Medialis - **Origin**: - Intertrochanteric line and medial lip of the linea aspera. - **Insertion**: - Patella and tibial tuberosity via the patellar ligament. - **Main Action**: - Extends the knee. - **Nerve Supply**: - Femoral nerve (L2, L3, L4). - **Trigger Point Referral Pain**: - Pain can be referred to the medial thigh and knee. #### 4. Vastus Intermedius - **Origin**: - Anterior and lateral surfaces of the shaft of the femur. - **Insertion**: - Patella and tibial tuberosity via the patellar ligament. - **Main Action**: - Extends the knee. - **Nerve Supply**: - Femoral nerve (L2, L3, L4). - **Trigger Point Referral Pain**: - Pain can be referred to the front of the thigh. ### **Hamstring Group** #### 1. Biceps Femoris - **Origin**: - Long head: Ischial tuberosity. - Short head: Linea aspera and lateral supracondylar line of the femur. - **Insertion**: - Head of the fibula. - **Main Action**: - Flexes the knee and extends the hip. - **Nerve Supply**: - Long head: Tibial part of sciatic nerve (L5, S1, S2). - Short head: Common fibular part of sciatic nerve (L5, S1, S2). - **Trigger Point Referral Pain**: - Pain can be referred to the back of the thigh and knee, sometimes to the calf. #### 2. Semitendinosus - **Origin**: - Ischial tuberosity. - **Insertion**: - Pes anserinus (medial surface of the tibia). - **Main Action**: - Flexes the knee and extends the hip. - **Nerve Supply**: - Tibial part of sciatic nerve (L5, S1, S2). - **Trigger Point Referral Pain**: - Pain can be referred to the back of the thigh and knee. #### 3. Semimembranosus - **Origin**: - Ischial tuberosity. - **Insertion**: - Posterior part of the medial condyle of the tibia. - **Main Action**: - Flexes the knee and extends the hip. - **Nerve Supply**: - Tibial part of sciatic nerve (L5, S1, S2). - **Trigger Point Referral Pain**: - Pain can be referred to the back of the thigh and knee. ### **Gluteal Muscles** #### 1. Gluteus Maximus - **Origin**: - Ilium (posterior gluteal line), sacrum, coccyx, and sacrotuberous ligament. - **Insertion**: - Iliotibial tract (IT band) and gluteal tuberosity of the femur. - **Main Action**: - Extends and laterally rotates the hip. - **Nerve Supply**: - Inferior gluteal nerve (L5, S1, S2). - **Trigger Point Referral Pain**: - Pain can be referred to the buttocks, sacrum, and lateral thigh. #### 2. Gluteus Medius - **Origin**: - External surface of the ilium between the anterior and posterior gluteal lines. - **Insertion**: - Lateral surface of the greater trochanter of the femur. - **Main Action**: - Abducts and medially rotates the hip. - **Nerve Supply**: - Superior gluteal nerve (L4, L5, S1). - **Trigger Point Referral Pain**: - Pain can be referred to the lateral hip and sometimes the lower back. #### 3. Gluteus Minimus - **Origin**: - External surface of the ilium between the anterior and inferior gluteal lines. - **Insertion**: - Anterior surface of the greater trochanter of the femur. - **Main Action**: - Abducts and medially rotates the hip. - **Nerve Supply**: - Superior gluteal nerve (L4, L5, S1). - **Trigger Point Referral Pain**: - Pain can be referred to the lateral hip and sometimes down the leg. ### **Adductor Muscles** #### 1. Adductor Longus - **Origin**: - Body of the pubis. - **Insertion**: - Middle third of the linea aspera of the femur. - **Main Action**: - Adducts and medially rotates the hip. - **Nerve Supply**: - Obturator nerve (L2, L3, L4). - **Trigger Point Referral Pain**: - Pain can be referred to the medial thigh and groin. #### 2. Adductor Brevis - **Origin**: - Body and inferior ramus of the pubis. - **Insertion**: - Pectineal line and proximal part of the linea aspera of the femur. - **Main Action**: - Adducts and medially rotates the hip. - **Nerve Supply**: - Obturator nerve (L2, L3, L4). - **Trigger Point Referral Pain**: - Pain can be referred to the medial thigh and groin. #### 3. Adductor Magnus - **Origin**: - Adductor part: Inferior ramus of the pubis and ramus of the ischium. - Hamstring part: Ischial tuberosity. - **Insertion**: - Adductor part: Linea aspera and medial supracondylar line. - Hamstring part: Adductor tubercle of the femur. - **Main Action**: - Adductor part: Adducts and medially rotates the hip. - Hamstring part: Extends the hip. - **Nerve Supply**: - Adductor part: Obturator nerve (L2, L3, L4). - Hamstring part: Tibial part of sciatic nerve (L4). - **Trigger Point Referral Pain**: - Pain can be referred to the medial thigh and groin. #### 4. Adductor Minimus - **Origin**: - Inferior ramus of the pubis. - **Insertion**: - Proximal part of the linea aspera of the femur. - **Main Action**: - Adducts and medially rotates the hip. - **Nerve Supply**: - Obturator nerve (L2, L3, L4). - **Trigger Point Referral Pain**: - Pain can be referred to the medial thigh and groin. #### 5. Pectineus - **Origin**: - Superior ramus of the pubis. - **Insertion**: - Pectineal line of the femur. - **Main Action**: - Adducts and flexes the hip. - **Nerve Supply**: - Femoral nerve (L2, L3) and sometimes obturator nerve (L2, L3). - **Trigger Point Referral Pain**: - Pain can be referred to the groin and upper medial thigh. #### 6. Gracilis - **Origin**: - Body and inferior ramus of the pubis. - **Insertion**: - Medial surface of the tibia (pes anserinus). - **Main Action**: - Adducts the hip and flexes the knee. - \*\*Nerve Supply **[Lower Leg]** ### **1. Gastrocnemius** - **Origin**: - Medial head: Medial condyle of the femur. - Lateral head: Lateral condyle of the femur. - **Insertion**: - Posterior surface of the calcaneus via the Achilles tendon. - **Main Action**: - Plantarflexes the foot at the ankle and flexes the knee. - **Nerve Supply**: - Tibial nerve (S1, S2). - **Trigger Point Referral Pain**: - Pain can be referred to the calf and back of the knee. ### **2. Soleus** - **Origin**: - Posterior surface of the head of the fibula and the soleal line of the tibia. - **Insertion**: - Posterior surface of the calcaneus via the Achilles tendon. - **Main Action**: - Plantarflexes the foot at the ankle. - **Nerve Supply**: - Tibial nerve (S1, S2). - **Trigger Point Referral Pain**: - Pain can be referred to the calf, heel, and sometimes the sole of the foot. ### **3. Plantaris** - **Origin**: - Lateral supracondylar line of the femur. - **Insertion**: - Posterior surface of the calcaneus via the Achilles tendon. - **Main Action**: - Weakly assists in plantarflexion of the foot and flexion of the knee. - **Nerve Supply**: - Tibial nerve (S1, S2). - **Trigger Point Referral Pain**: - Pain can be referred to the back of the knee and calf. ### **4. Popliteus** - **Origin**: - Lateral condyle of the femur and lateral meniscus. - **Insertion**: - Posterior surface of the tibia above the soleal line. - **Main Action**: - Medially rotates the tibia to unlock the knee and flexes the knee. - **Nerve Supply**: - Tibial nerve (L4, L5, S1). - **Trigger Point Referral Pain**: - Pain can be referred to the back of the knee. ### **5. Peroneals (Fibularis Muscles)** #### Peroneus Longus - **Origin**: - Head and upper two-thirds of the lateral surface of the fibula. - **Insertion**: - Base of the first metatarsal and medial cuneiform. - **Main Action**: - Everts and plantarflexes the foot. - **Nerve Supply**: - Superficial fibular nerve (L5, S1, S2). - **Trigger Point Referral Pain**: - Pain can be referred to the lateral leg and foot. #### Peroneus Brevis - **Origin**: - Lower two-thirds of the lateral surface of the fibula. - **Insertion**: - Tuberosity of the fifth metatarsal. - **Main Action**: - Everts and plantarflexes the foot. - **Nerve Supply**: - Superficial fibular nerve (L5, S1, S2). - **Trigger Point Referral Pain**: - Pain can be referred to the lateral foot and ankle. ### **6. Tibialis Anterior** - **Origin**: - Lateral condyle and upper two-thirds of the lateral surface of the tibia and interosseous membrane. - **Insertion**: - Medial cuneiform and base of the first metatarsal. - **Main Action**: - Dorsiflexes and inverts the foot. - **Nerve Supply**: - Deep fibular nerve (L4, L5). - **Trigger Point Referral Pain**: - Pain can be referred to the front of the ankle and big toe. ### **7. Tibialis Posterior** - **Origin**: - Posterior surface of the tibia and fibula, and interosseous membrane. - **Insertion**: - Navicular, cuneiforms, cuboid, and bases of the second to fourth metatarsals. - **Main Action**: - Plantarflexes and inverts the foot. - **Nerve Supply**: - Tibial nerve (L4, L5). - **Trigger Point Referral Pain**: - Pain can be referred to the arch of the foot and posterior medial ankle. ### **8. Extensor Digitorum Longus** - **Origin**: - Lateral condyle of the tibia, upper three-fourths of the anterior surface of the fibula, and interosseous membrane. - **Insertion**: - Middle and distal phalanges of the four lesser toes. - **Main Action**: - Extends the toes and dorsiflexes the foot. - **Nerve Supply**: - Deep fibular nerve (L5, S1). - **Trigger Point Referral Pain**: - Pain can be referred to the top of the foot and toes. ### **9. Extensor Hallucis Longus** - **Origin**: - Middle part of the anterior surface of the fibula and interosseous membrane. - **Insertion**: - Base of the distal phalanx of the big toe. - **Main Action**: - Extends the big toe and dorsiflexes the foot. - **Nerve Supply**: - Deep fibular nerve (L5, S1). - **Trigger Point Referral Pain**: - Pain can be referred to the top of the foot and big toe. ### **10. Flexor Digitorum Longus** - **Origin**: - Posterior surface of the tibia. - **Insertion**: - Bases of the distal phalanges of the four lesser toes. - **Main Action**: - Flexes the toes and plantarflexes the foot. - **Nerve Supply**: - Tibial nerve (L5, S1, S2). - **Trigger Point Referral Pain**: - Pain can be referred to the bottom of the foot and toes. ### **11. Flexor Hallucis Longus** - **Origin**: - Lower two-thirds of the posterior surface of the fibula and interosseous membrane. - **Insertion**: - Base of the distal phalanx of the big toe. - **Main Action**: - Flexes the big toe and plantarflexes the foot. - **Nerve Supply**: - Tibial nerve (L5, S1, S2). - **Trigger Point Referral Pain**: - Pain can be referred to the bottom of the foot and big toe. This list provides detailed information about each of the specified muscles, including their origin, insertion, main action, nerve supply, and trigger point referral pain. If you need more information or additional muscles, feel free to ask!