1. Functional anatomy of the muscles of the limbs
Development of the limb muscles
Peculiarities of the limb muscles
Auxiliary apparatus of the limb muscles
Differences of the upper and lower limb muscles
Topography of the upper limb
Topography of the lower limb
Weak places of the pelvis and hernias

2. Development of the limb muscles
It is supposed that muscles of the limbs are developed from the cells of the ventral myotomes which migrate into the mesenchyme bud of the limb.
Muscles which are inserted to the bones of free limb with both ends form the Autochthonous group of the muscles.
Some muscles which are derivatives of migrated cells move one its end to the trunk and become inserted to it. Such muscles form the Trunkopetal group of the muscles (e.g. pectoral major and minor muscles, latissimus dorsi muscle).
The third group is developed from the myotomes of the trunk and is inserted with one end to the bones of the limb forming the Trunkofugal muscles ( trapesium m., rhomboid mm., levator scapulae m., anterior serrate m).
At the lower limbs trunkofugal muscles are absent.
Trunkopetal muscles of the lower limb: greater psoas m., quadratus lumborum m..

3. Peculiarities of the limb muscles
Big amount of the long muscles
Presence of big amount of muscular annexions:
- retinaculi,
synovial vagines,
synovial bursae,
tendinous vinculae,
fibromuscular canals.

4. Localization of the limb muscles
Muscles have perpendicular direction to the axis of movement at the joint.
Minimum one pair of muscles /one by one for opposite movements/ exist for each axis.
Function of each muscle depends on the its position to the axis of movement.

5. Retinaculi of the upper limb
Retinaculum flexorum
Canalis carpi radialis:
tendon m. flexor carpi radialis.
Canalis carpalis:
Synovial vagines of tendons of muscles
flexor digitorum,
tendon of m.flexoris pollicis longus,
nervus medianus.
Canalis carpi ulnaris:
Arteria ulnaris
Vena ulnaris
Nervus ulnaris

6. Retinaculi of the upper limb
Retinaculum extensorum
/6 canals transmitting tendons/
I - m.abductor pollicis longus
m.extensor pollicis brevis
II - m.extensor carpi radialis longus
m.extensor carpi radialis brevis
III - m.extensor pillicis longus
IV – m.extensor digitorum
m. extensor indicis
V - m. extensor digiti minimi
VI – m.extensor carpi ulnaris

7. Synovial sheaths of the palmar and dorsal surface of the hand

8. Retinaculi and synovial sheaths of the lower limb
Retinaculum extensorum
It presses the tendons of the anterior leg muscles to the bones
It has 2 parts:
1. Upper /between the leg bones above the malleoli/
2. Lower /distally in front of the ankle joint, Y-shaped/
- originates from the lateral surface of the calcaneus and tarsal sinus
separates into two bands:
a) superior - passes to the medial malleolus;
b) inferior – to the navicular and medial cuneiform bones
It splits into a superficial and deep layers the extensor tendons forming four fibrous canals
I – synovial vagine of the extensor digitorum longus andperoneus tertius m
II - synovial vagine of the extensor hallucis longus
III- synovial vagine of the tibialis anterior muscle
IV – blood vessels and nerve

9. Retinaculi and synovial sheaths of the lower limb
Retinaculum flexorum
Passes from the calcaneus to the medial malleolus
Forms 4 osteofibrous canals:
I – synovial vagine of the tibialis posterior,
II - synovial vagine of the flexor digitorum longus,
III – synovial vagine of the flexor hallucis longus,
IV – posterior tibial artery and tibial nerve.

10. Retinaculi and synovial sheaths of the lower limb
Retinaculum peroneorum
It has 2 parts:
1) Upper
- from the lateral malleolus to
the calcaneus,
- transmits the common synovial
vagine of the peroneus longus and
brevis muscles
Lower
- located on the lateral surface of
he calcaneum,
- transmits separated synovial
vagines of the peroneus longus
and brevis muscles.

11. Synovial vagines and the grooves of the plantar surface

12. Differences of the muscles of the upper and lower limbs
Amounts of the muscles of upper limbs is bigger
Volum and weight of the muscles is bigger at the lower limbs
Lower limbs haven’t group of the muscles pronators
Pelvic girdle doesn’t have proper muscles, these muscles are well developed at the shoulder girdle
Flexors prevail at the upper limbs, extensors – at the lower limbs.
Lower limbs have well developed group of adductors.
Muscles of the upper limbs have small surface of attachment to the bones.
At the upper limb point of effort is placed closely to the fulcrum than at the lower limb.

13. Topography of the upper limb
Axillary fossa
It is seen in abduction
It is bounded: inferiorly by the greater pectoral m. in front;
by the latissimus dorsi and teres major m. – behind;
medially – by an imaginary line between borders of these mm. on
the chest
laterally – by a connecting line on the inner surface of the upper
arm.
Axillary cavity
Anterior wall – major and minor pectoral muscles:
3 triangles clavipectoral
pectoral
infrapectoral;
Posterior wall – subscapular m.
teres major m.
latissimus dorsi m.;
2 oppenings
trilaterum = triangular
quadrilaterum = quadrangular;
Medial wall – serratus anterior m.
Lateral wall – humarus + muscles.

14. Topography of the shoulder girdle
Deltoideopectoral triangle (groove) - a
Lateral and medial bicipital grooves – b, c

15. Topography of the upper limb
1. Canal of the radial nerve = canalis spiralis = canalis humeromuscularis:
between the humerus and triceps muscle
2. Fossa of beauty:
on the posterior surface of the elbow joint
3. Gluter’s triangle and line:
connect the epicondyles and apex of the olecranon

16. Topography of the forearm
Canal of the ulnar nerve: between the medial epicondyle, proximal ulna and origin of the forearm flexors
Canalis supinatorius: between the supinatorius muscle and radius
Pirogov’s space: between the third and fourth layers of the forearm muscles at its distal part.

17. Topography of the forearm and hand
Elbow fossa:
laterally – brachioradial m.,
medially – pronator teres m.,
superiorly – brachial m..
Antebrachial grooves:
Lateral = radial: between brachioradial and flexor carpi radialis mm;
Median: between flexor carpi radialis and flexor digitorum superficialis mm ;
Medial = ulnar: between flexor digitorum superficialis and flexor carpi ulnaris mm .
Anatomical snuff-box

18. Suprapirifom and infrapiriform oppenings
The piriform foramen passes through the greater sciatic foramen, above and below which narrow openings remain and transmit the gluteal vessels and nerves.

19. Lacuna musculorum: Lacuna vasorum: Femoral triangle:
Above – inghinal lig,; laterally – sartorius m.; medially – arcus ileopectineus.
Lacuna vasorum:
Above – inghinal lig,; laterally – arcus ileopubicus; medially – lig. lacunare;
behind – arcus ileopectineus.
Femoral triangle:
Laterally – sartorius m.;
Above – inghinal ligament;
Medially – adductor
longus m.
Canalis adductorius:
Laterally – medial belly
of cvadriceps m.;
magnus m.;
Anteriorly - membrana
vastoadductoria.

20. Femoral canal Under normal conditions doesn’t exist. Walls:
Lateral – femoral vein;
Posterior – deep layer of fascia lata femoris;
Anterior – inghinal ligament and superior horn of the crescent-shaped margin of fascia lata.
There is a narrow opening in the medial corner of lacuna vasorum – the femoral ring = inlet
Laterally – femoral vein;
Anterior and superior – Poupart’s ligament;
Medially – lacunar ligament;
Posterior – pectineal ligament.
Outlet – chiatus saphenus.
Femoral canal

21. Canals of the leg Grouber’s canal = canalis cruropopliteus
Extends between the superficial and deep mm. of the leg.
It gives a branch – canalis musculoperoneus inferior formed by the middle third of the fibula and the flexor hallucis longus.
Canalis musculoperoneus superior – it is placed in the upper third of the leg, between the fibula and peroneus longus muscle.
Pirogov’s canal – it is a fascial canal located between two heads of the gastrocnemius muscle.

22. Weak places of the pelvis
Obturator canal
Suprapirifom foramen
Infrapiriform foramen
Obturator Hernia: This extremely
rare abdominal hernia develops mostly
in women. This hernia protrudes from
the pelvic cavity through an opening
in the pelvic bone (obturator foramen).
This will not show any bulge but can
act like a bowel obstruction and cause
nausea and vomiting.

23. Ischiatic and obturator hernias
Ischiatic hernias:
Suprapiriform hernia;
Infrapiriform hernia;
Hernia of the lesser piriform
foramen

24. 2 – anterior peroneal hernia; 7 - posterior peroneal hernia.
Perineal hernias
2 – anterior peroneal hernia; 7 - posterior peroneal hernia.

25. Femoral hernias Femoral Hernia: It occurs when the intestine enters
the canal carrying the femoral artery into the upper
thigh.
Femoral hernias are most common in women, especially
those who are pregnant or obese.

26. End