Head Muscles
Most of the head muscles are found in the face region. The roof of the head is covered subcutaneously by a tendon called the galea aponeurotica; This tendon is tightly attached to the skin and loosely attached to the periosteum. Starting place m. frontalis and end m. ‘occipitalis’. When these muscles contract, the galea aponeurotica moves forward and backward with the skin. Facial muscles are divided into two groups: 1. Mimic muscles, 2. Chewing muscles.
1. Mimic muscles: These are the muscles whose starting places are bone and ending places are skin. These muscles are located on the face and when they contract, facial changes are observed. These changes are called facial expressions.
The largest mimic muscles are: 1. M. frontalis, 2. M. orbicularis oculi, 3. M. orbicularis oris, 4. M. buccinatorus, 5. M. quadratus (levator) labii inferioris, 6 M. zygomoticus minor and major, 7. M. risorius (laughing muscle).
M. frontalis is located under the forehead skin and wrinkles the forehead skin. M. orbicularsi oculi is in the eyelids, and m. The orbicularis oris is located within the lips, when contracted, the mouth is closed. M. buccinator is on the buccal wall, the cheeks adhere to the teeth when contracted. The inferior and superior muscles of the M. quadratus labii pull the lips down and up.
2. Chewing muscles: These muscles extend between the skull bones and the mandible. Contractions make chewing and speaking movements.
There are four pairs of chewing muscles: 1.M. masseter, 2. M. temporalis, 3. M. pterygoideus lateralis, 4. M. pterygoideus medialis.
M. masseter extends between the zygomatic arc (arcus zygomaticus) and the outer surface of the mandible corner. When contracted, it pulls the mandible upwards and closes the mouth. M. temporalis starts from temporal bone and zygomatic arc, proc of mandible bone. terminates in coronoidea. Lifts the lower jaw. A tight fascia surrounds the muscle. M. pterygoideus lateralis, the pterygoid extension of the sphenoid bone (prroc. pterygoideus) and the proc of the mandible. It grows between its articularis. If it contracts on one side, it shifts the mandible in the opposite direction. The muscles of the two sides, if they work together, shift the mandible in the opposite direction. If the muscles of both sides work together, they will bring the mandible forward. M. pterygoideus medialis extends between the pterygoid process and the inner surface of the corner of the mandible. Lifts the mandible. In this way, the masticatory muscles lift the mandible and move it forward.
Neck Muscles
Neck muscles are divided into four groups: 1.M. Platysma (flat muscle of the neck), 2.M.Sternocleidomastoideus, 3. Subhyoid and suprahyoid muscles, 4. Deep (Profundus) muscles.
1. M. platysma is a broad and thin muscle under the skin on the lateral surface of the neck. When contracted, the skin of the neck is stretched and the corners of the mouth are pulled down. It is not very developed in humans.
2. M. sternocleidomastoideus is the largest muscle in the neck. The clavicle extends between the sternum and the mastoid appendage (temporal bone). It is a long muscle that appears easily under the skin. When contracted on one side, it turns its head to its side, face up and to the opposite side. They keep the head upright in bilateral contractions. Unilateral stroke (paralysis) in this muscle is very common. In this case, since the opposite muscle will contract, the patient’s head looks up and to the side on the side of the muscle with the stroke. This phenomenon is called Torticollis (looking to the sky).
3. A. Suprahyoid muscles: They are located on the upper side of the hyoid bone. There are four of them: M. digastricus, M. mylohloideus, M. geniohyoideus, M. stylohyoideus. Contractions of these muscles lift the hyoid bone and aid in swallowing. From the first three muscles and the tongue muscles, m. geniohyoideus also make the floor of the mouth. These muscles pull the mandible down while the hyoid is fixed.
B. Subhyoid muscles: They are located in the lower part of the hyoid bone, they are flat muscles. There are four of them: M. sternohyoideus, M. sternothyroideus, M. thyrohyoideus, Momohyoideus. These muscles pull the hyoid bone down and cover the thyroid gland, larynx, and anterior part of the trachea.
4. Deep muscles: These are the muscles located deep in the neck region. These are called scalene muscles (M. scalenius anterior, medius and posterior) and M. longus colli and M. longus capitis. The scalene muscles are the muscles that are arranged in a row between the neck vertebrae and the 1st and 2nd costae. If the neck is fixed, they raise the chest and thus assist breathing. If the chest is fixed, the neck bends to the contracted side.
5. Tongue muscles: There are striated muscles in the tongue that give the shape of the tongue and extend transversely, longitudinally and obliquely. In addition, there are muscles extending from the root of the tongue to the tip of the mandible, the hyoid bone, and the temple. These make the movements of the tongue: M. genioglossus, m. hyoglossus and m. styloglossus muscles.
Chest Muscles
Chest muscles are divided into two groups: 1. Muscles ending in the upper lateral bones, 2. Special chest muscles.
Group 1 muscles: The muscles in this group end in the upper lateral (upper extremity) bones. M. pectoralis major, M. pectoralis minor, M. subclavius and M. serratus anterior.
M. pectoralis major is a superficially located and bulging muscle in the anterior chest wall. It begins at the clavicle and sternum and ends at the upper end of the humerus. Coke makes adduction. If the arm is fixed, it removes the ribs. If the arm is up, it pulls the arm down or raises the ribs.
M. pectoralis minor is located below the pectoralis major. It starts from 2 – 5 costae and ends at the coracoid process (Scapula). Pulls the scapula downward and forward. If the scapula is fixed, it raises the ribs.
M. sublavius extends between the first costa and the clavicle. When it contracts, it pulls the clavicle down and inward.
M. serratus anterior is located on the lateral surface of the chest wall. It starts from 1 – 8 costa and ends at the medial edge and lower corner of the scapula. When contracted, it pulls and rotates the scapula forward and outward.
Group 2 muscles: There are two special muscles in the chest. M. intercostalis externa, M. intercostalis interna. These muscles are located in the intercostal space. The external muscle (external) lifts the costa and thus allows breathing. The inner intercostal muscle pulls the ribs down and provides exhalation in this way.
Diaphragm
This muscle is usually described together with the pectoral muscles. It is a flat, non-paired muscle that separates the thoracic and abdominal cavities
. The middle part makes a dome.
This part is in the muscle-tendon structure and the tendogenous part is called the centrum tendineum. The diaphragm starts from the sternum, costae, and lumbar vertebrae. Accordingly, it is divided into three parts. Lumbal, costal and stenal parts of the diaphragm are named.
There are three large holes in the diaphragm. These are anterior to posterior peak (Hiatus aorticus, Hiatus oesophageus and Foramen venae cavae).
Hiatus aorticus and Hiatus oesophageus holes are located from the lumbar part of the diaphragm. In the middle tendogenous part, there is a hole through which the inferior V. cava passes.
The diaphragm assists respiration and is considered the main muscle of respiration. If it contracts, it goes down and the chest cavity expands, breathing in and the lungs enlarging. When it relaxes, it returns to its previous state, the thorax contracts, and the exhale is exhaled.
Some of the thoracic and abdominal organs are adjacent through the diaphragm.
Diaphragm Clinical Information
It is clinically important to consider the diaphragm in three dimensions. The places where the crus of the dome-shaped organ are attached are below and most of them cannot be seen on AP x-rays. Normally the right half is higher. However, the position of the levels of both halves of the diaphragm relative to the rib and vertebral levels may change due to the following three factors.
1. The phase of respiration.
2. The state of the body
3. The size and tension of the intra-abdominal organs.
1. The upper border of the diaphragm fluctuates 1.5-2.5 cm in calm breathing. In strong breathing, this play can be up to 10 cm.
2. The diaphragm is at its highest level when the individual is in the supine position. Because the intra-abdominal organs push the diaphragm towards the thorax. This case shows us why the patient with dyspnea prefers to stand upright instead of lying down.
3. The right half of the dome is slightly higher when standing upright, since a mass formation such as the liver is located under the diaphragm on the right.
The diaphragm is an important respiratory muscle.
Respiration consists of two phases called inspiration. During inspiration, the thoracic cavity expands, increasing the vacuum. The elastic lung, which is sucked in by the vacuum, inflates like a balloon and fills them with air. Expiration (except in special cases such as coughing, sneezing, playing the wind instrument) is a completely passive event. It is the event that the Thorax wall and lungs deflate again with their elasticity.
500 cc in calm breathing. Air is taken in and out. In calm breathing, the following muscles contract:
a. diaphragm.
b. mm in the upper intercostal spaces. intercostales interni.
c. (in some individuals) scalene muscles.
Accordingly, the most important muscle of inspiration is the diaphragm.
For inspiration, it is useful to keep in mind the following fact. Whether the force pulling the thoracic wall upwards is applied to a single rib or cartilage or to the sternum, it creates a common effect on the entire thoracic wall, causing the cavity to expand.
In deep (forceful) breathing, the thoracic curvature of the spine is stretched and straightened by contraction of the M. erector spinae. Thus, the anteroposterior diameter of the Thorax expands more in the pump arm movement. Also, in this case, the lateral expansion in the lower ribs is excessive.
Top of diaphragm, 10 cm on strong breathing. it can go down. This increases the height of the thorax.
The central tendon of the diaphragm, which contracts excessively during strong breathing, increases the intra-abdominal pressure to a certain extent, and plays a role like origo by not being able to go down. In this case, the contracted diaphragmatic fibers elevate the 7th-12th ribs. In vigorous breathing, all respiratory and accessory respiratory muscles are active.
Scalene muscles and M. Sternomastoideus are the most important accessory respiratory muscles. It raises the entire rib cage by pulling up the 1st – 2nd ribs and the sternum. In case of strong expiration, such as coughing, these muscles contract well. Thus, the possibility of injuring the tops of the lungs by pulling the upper ribs downwards is prevented. These muscles are usually active in the event of dyspnea.
During strong expiration, the intercostal muscles contract. In this case, it is thought that the muscles regulate the tension of the intercostal spaces and prevent the spaces from ballooning outward in the face of increased intrathoracic pressure.
Control of inspiration is necessary when a singer is singing a long note or playing a wind instrument. It is important to gradually loosen the diaphragm and identify its origin, the 12th rib. The M. quadratus lumborum contracts and fixes the 12th rib.
N. phrenicus palsy: The two halves of the diaphragm are innervated separately. In that respect, one side works in the phrenic nerve cut, the other side works. Normally, however, the two sides contract synchronously.
Firenic nerve palsy is mostly seen in intrathorax tumors. Unilateral paralysis is best diagnosed radiologically. The paralyzed half rises on inspiration instead of descending due to increased intra-abdominal pressure. It makes the reverse movement in expiration. The movement of the paralyzed half is the opposite of the healthy side.
Dyspnea (respiratory failure) occurs in bilateral paralysis.
Diaphragm alone is responsible for 60% of respiration.
Shoulder Muscles
There are six muscles in the shoulder. These are M. deltoideus, M. supraspinatus, M. infraspinatus, M. subscapularis, M. teres major and M. teres minor muscles.
M. deltoideus starts from spina scapula and clavicle of Scapula, ends at Tuberositas deltoidea of Humerrus. It is a big muscle, it raises the shoulder. It makes the arm horizontal by abduction.
M. supraspinatus extends between the fossa supraspinata of the scapula and the greater tuberculum at the upper end of the humerus. It abducts the arm together with the deltoid muscle.
M. infraspinatus extends between the fossa infraspinata of the scapula and the tuberculum majos of the humerus. Rotates the arm inward.
M. subscapularis extends between the Fossa subscapularis on the anterior aspect of the scapula and the Tuberculum minus of the Humerus. Rotates the arm inward.
M. teres major is a round muscle that lies between the lateral margin of the Scapula (margo lateralis) and the sulcus intertubercularis of the Humerus. Rotates the arm inward.
M. teres minor is a small round muscle lying between the lateral edge of the scapula and the Tuberculum majus of the Humerus. Rotates the arm outward.
Arm Muscles
Arm muscles are divided into two as anterior and posterior muscles. anterior muscles three; are:
1.M. The biceps brachii is located superficially on the arm. It has two heads (long and short) starting from the scapula. This muscle terminates at the tuberositas radii of the radius. This muscle, which is easily seen under the skin, is also called the biceps muscle. Bends (flexes) the forearm, acting on the elbow joint.
2. M. brachialis is located under the biceps muscle. Humerus and Ulna Proc. It extends between its coronoideus. It bends the forearm.
3. M. Coracobrachialis extends between the coracoid process of the Scapula (Proc. coracoideus) and the Humerus. Bends and adducts the arm.
M. triceps brachii is found as the posterior muscle. It has three heads. Its long head starts from the Scapula and the other two heads from the Humerus. These three heads terminate in the Olecranon of Ulna. Stretches the forearm (extension)
Forearm Muscles
Forearm muscles are divided into two as anterior and posterior muscles. Most of the anterior muscles originate from the medial epicondyle of the humerus (condylus medialis), while the posterior muscles originate from the lateral epicondyle (condylus lateralis).
Anterior muscles:
1. M. Flexor carpi radialis and ulnaris: They originate from Epicondylus medialis and Olecranon and end at Os psiforme, Os hamatum and 5th metacarpal bone from the wrist bones. They bend the hand (flexion) and make adduction movements.
2. M. Flexor digitorum superficialis: It emerges from the epicondylus medialis, Processus coronoideus and Corpus radii with a common tendon, and attaches to both sides of the 2nd and 5th fingers. It causes the Phalanx media and Digiti manus of the 2nd and 5th fingers to flex.
3. M. Flexor digitorum profundus: It originates from the anterior and medial surface of the ulna and the Mebrana interossea, and ends in the Phalanx tertia of the 2nd – 5th fingers. Flexes the Phalanx media and Digiti manus of the 2nd and 5th fingers.
4. M. Flexor pollicis longus: It originates from the anterior surface of the radius and the interossea of the membrane and ends in the first phalanx of the thumb. It is the flexor of the thumb.
5. M. Pronator teres: From Caput humeral and Epicondylus medialis and Caput ulnare with Proc. It originates from the coronoideus ulnae and terminates on the outer surface of the middle part of the radius. The pronation movement of the forearm and hand also flexes the forearm.
6. M. Pronator quadratus: They originate from the anterior aspect of the lower part of the ulna, and terminate on the anterior aspect of the lower part of the Radius. They rotate the radius and hand inward (supination).
Forearm Posterior Muscles:
1. Three extensor muscles: M. Extensor carpi radialis brevis, M. Extensor carpi radialis longus and M. extensor carpi ulnaris. They arise from the epicondylus lateralis. They terminate in the Ulna, Radius, and Metacarpal bones.
2. M. Extensor digitorum communis: It emerges from the epicondylus lateralis and divides into four tendons that go to the Phalanxes of the 2nd – 5th fingers. This makes the fingers stretch.
3. M. Extensor pollicis longus and brevis: Two muscles that stretch the thumb. They terminate in the Phalanxes of this finger.
4. M. abductor pollicis longus: It ends at the 1st metacarpal bone. Abduction of the thumb.
5. M. Supinatorius: It arises from the collateral ligaments of the epicondylus lateralis and the elbow joint. It terminates on the outer surface of the radius. Supinates the hand. In other words, it makes the palm of the hand drink water.
6. M. brachioradialis emerges from the Crista supracondylaris and extends over the lateral aspect of the forearm. It starts from the 1/3 lower outer side of the humerus and ends at the radius. Flexes the forearm and rotates the Radius.
Hand muscles: The muscles of the palmar face (palm) are divided into three groups: 1. Thenar muscles, 2. The middle muscles, 3. The hypothenar muscles. Thenar muscles make the thumb, hypothenar muscles make the little finger ridge, they make the movements of these fingers. There are many small muscles between the metacarpal bones.
Armpit and Elbow Pit
In the upper lateral part of the body, there are two important places called Fossa cubiti (elbow pit) and Axilla (armpit):
Axilla: Also called armpit This region borders M. pecrora1is major from the front, M. subscapularis from the back, upper end of the humerus from the outside and the muscles adjacent to the arm, and M. serratus anterior from the inside. The axilla contains loose connective tissue, blood vessels (A., V. axilaris), numerous lymph nodes and nerves (N. radialis, madianus, ulnaris). Arm, forearm, hand and breast (especially important in breast cancer) lymph comes to the lymph nodes. Body temperature is measured from here.
Fossa cubiti: It is the hollow place between M. pronator teres and M. brachioradialis in front of the elbow joint. A. brachialis is found deep, and superficial veins subcutaneously. Intravenous injection is applied to the superficial veins here.
Superficial Back Muscles
Back muscles are divided into two groups. 1. Muscles ending in the upper lateral bones (M. Trapezius, M. Latissimus dorsi, M. Rhomboideus and M. Levator scapulae). 2. Back special muscles (M.Serratus posterior and M. Serratus inferior, M. Splenius, M. Sacrospinalis).
1. M. trapezius is a broad flat muscle located under the skin in the upper back. League with Os Occipitale. nuchae and thoracic vertebrae Proc. It starts from spinalis and ends at Clavicula and Spina scapulae. The muscle has three parts, the upper, middle and lower parts. When contracted, the scapula is pulled towards the spine.
2. M. latissimus dorsi is a flat muscle under the skin on the lateral part of the thorax and the lower part of the back. It starts from the distal six thoracic vertebrae, the lumbosacral fascia, and the crista iliaca (ilium) and terminates in the Sulcus intertubercularis of the Humerus and the crista tuberculi minoris. If it contracts, the arm abducts and is pulled down.
3. M. Rhomboideus is located under the upper part of M. Trapezius. 6.-7. It starts from the neck and the first four thoracic vertebrae and ends at the medial edge of the Scapula (Margo medialis). It pulls the scapula to the spine.
4. M. Levator scapulae, Proc. It emerges from its transversus, the inner edge and upper angle of the scapula (Angulus superior scapulae) ends. Pulls the scapula up.
5. M. Splenius is the head and neck muscle. It is located under M. Trapezius, on the back of the neck. If the muscles of both sides contract together, they pull the head back, when the muscle of only one side contracts, the head turns to that side.
Abdominal Muscles
There are five abdominal muscles. M. Obliquus abdominis externus, M. Obliquus abdominis internus, M. Transversus abdominis, M. Rectus abdominis and M. Quadratus lumborum. They are located between the thoracic and pelvic bones and form the abdominal walls. M. obliqus abdominis externus, internus and transversus abdominis are broad, flat muscles. They have tendons or aponeuroses.
1. M. obliquus abdominis exterus (external curved muscle of the abdomen), muscle fibers 6.-8. It starts from the costa and extends forward to the midline. It terminates at the crista iliaca of the ilium bone. The lower edge of the muscle aponeurosis makes a ligament and this ligament is called Lig. it is called inguinale (Poupart ligament). This ligament, also called the inguinal ligament, extends between the spina iliaca anterior superior of the ilium bone and the tuberculum pubicum of the pubis.
2. M. obliquus abdominis internus, (internal curved muscle of the abdomen); located under the previous muscle. League with Crista iliaca. It starts from the inguinale. The muscle bundles extend forward and upward and terminate in the lower ribs.
3. M. transversus abdominis, (transverse muscle of the abdomen), located below the previous muscle. Cartilage of the last six ribs, crista iliaca and Lig. are the starting places of the inguinale. Muscle fibers and bundles extend horizontally and terminate in the aponeurosis at the midline.
4. M. rectus abdominis, (smooth muscle of the abdomen), is located on the outer side of the midline and is located on the 5th -7th. It extends between the cartilage parts of the costae and the pubis bone. Muscle fibers extend vertically to the ground. The muscle is surrounded by 3-4 aponeuroses. These aponeuroses belong to M. obliqus abdominis externus and M. obliquus internus and M. transversus abdominis muscles.
5. M. quadratus lumborum is located between the 12th costa and the crista iliaca. Together with the lumbar region of the spine, it makes the posterior wall of the abdominal cavity.
Abdominal internal pressure increases in contractions of the anterior abdominal wall muscles and diaphragm, and they help with defecation, voiding and birth events. These muscles also assist in breathing, as they are associated with the ribs. When the M. rectus abdominis and oblique muscles of the abdomen contract, they bend the trunk forward (flexion). The oblique muscles of the abdomen also make the trunk rotate to the right and left.
Abdominal fascia: M. obliquus externus is surrounded by a thin fascia. The abdominal cavity wall is covered by the peritoneum and surrounded by the inner abdominal fascia. In some places on the abdominal wall, the internal organs pierce these fasciae and approach the skin. In this way, hernias (Hernia) are formed. These are mostly observed in the inguinal canal, linea alba and navel.
Canalis inguinalis: In intrauterine life, a canal is formed in the lower part of the anterior abdominal wall of both sexes by perforating all layers of the wall. This canal, named canalis inguinalis, occurs when an extension of the peritoneum that covers the anterior abdominal wall from the inside is pulled down and it goes under the skin by piercing all layers of the abdominal wall. To this peritoneal extension Proc. called vaginalis. Proc. The vaginalis, after passing through the anterior abdominal wall, is inserted into a ridge called the Torus genitalis. The scrotum in males and the labium majus of the vagina in females are formed from the torus genitalis. The channel formed in this way remains open and widens in men. Between the seventh and ninth months of embryonic life, the testicles, which are located in the abdominal cavity at the beginning, descend into their bags by following this path. After the testicles descend, Proc. The leaves of the vaginalis stick together and a peritoneal scar occurs on the inner surface of the anterior abdominal wall at the beginning of this peritoneal extension above (Sicatricula inguinalis).
In female fetuses, in the third month of embryonal life, the Proc.vaginalis normally closes completely and the outline of the inguinal canal is not enlarged as in males.
After the external and internal genital organs are formed and take their normal places, the sperm cord (funiculus spermaticus) descends from the inguinal canals into the bags in men and joins with the testis. There is a bond called teres. The canal is usually narrower in women than in men.
The length of the inguinal canal is 4-5 cm. It passes between the muscles and membranes that make the anterior abdominal wall in an inclined state, from outside to inside and from top to bottom. The hole of the canal opening into the abdominal cavity is called Anulus inguinlais profundus. At this height, the peritoneum covering the inner surface of the anterior abdominal wall makes a depression and the pit formed in this way is called Fossa inguinalis lateralis. All formations that make up Funiculus spermaticus pass through this hole (Anulus ingunalis profundus) and are inserted into the inguinal canal. The outer hole of the canal is located under the skin 1.5-2 cm outside of the Tuberculum pubicum. This hole is called Anulus inguinalis superficialis. The outer hole of the inguinal canal is formed by the separation of the beam beams of the aponeurosis of M. obliquus externus obdominis from one here.
We can feel the outer hole of the inguinal canal under the skin in living things. If we push the soft skin in the upper part of the scrotum and insert our finger outwards, upwards and slightly back, we can hear the sharp edge of the Anulus ingunalis superficialis. Normally, we can only insert the tip of our finger into the hole.
The inguinal canal has four walls: upper, lower, anterior and posterior. Aponeurosis of M. obliquus externus abdominis anterior wall, Lig. inguinale, the upper wall of M. obliquus internus and M. transversus, the lower edges and posterior wall of Fascia transversalis and Peritoneum. The weakest of this wall is the back wall.
On the inner surface of the anterior abdominal wall, there is the fovea inguinalis lateralis, which we have described above and which corresponds to the inner hole of the ingunial canal. A second slight pit is seen in the interior. This pit, called fossa inguinalis medialis, passes under the skin by passing through the outer arm of the inguinal canal, and hernias formed in this way can descend into the scrotum by following Funiculus spermaticus.
Linea alba, M. obliquus externus and M. obliquus internus, M. transversus abdominis is a structure in the form of a white line extending from top to bottom, formed by merging of the aponeurosis of the muscles on the midline. Linea alba Sternum’s Proc. It lies between its xiphoideus and Symhysis pubis.
The navel (umbilicus) is located in the middle of Linea alba. It remains as a trace of the umbilical ring after birth. The umbilical cord passes through this ring in fetal life.
Pelvis Muscles
Pelvis muscles internal muscles (M. iliopsoas, M. piriformis and M. obturatorius internus) and external muscles (M. gluteus maximus and M. gluteus minimus, M. obturatorius externus) , M. quadratus femoris, M. tensor fasciae latae).
Internal muscles
1. M. iliopsoas starts from the lumbar vertebrae and fossa iliaca (ilium). It has two parts. The liga extends from under the inguinale to the femur. It ends in the Trochanter minor of the femur. This muscle acts on the hip joint and flexes the thigh, with very little external rotation.
M. Iliopsoas Clinical Information
1. The neighborhood of the iliopsoas muscle has clinical importance. If the Kidneys, Ureters, Caecum, Appendix, Sigmoid colon, Pancreas, Lumbal lymph nodes or Lumbal nerves are diseased, the movements of the Iliopsoas can be painful. Since the muscle is based on the spine and sacroiliac joint, disc or sacroiliac joint diseases can cause iliopsoas spasm.
2. When tuberculosis spreads through the blood to the vertebrae, they may migrate from the lumbar vertebrae into the iliopsoas muscle, causing psoas abscesses. Since the fascia of M. psoas resembles a stocking, this type of abscess may pass into the thigh and become superficial in the femoral triangle.
3. The lower part of the fascia iliaca is tense. The upper half is very loose. Sometimes it even forms a pocket called the fossa iliacosubfascialis. A portion of the large intestine can enter this pocket.
2. M. priformis starts from the anterior surface of the Sacrum and ends at the trochanter major of the femur. It rotates the thigh outward (external rotation).
3. M. obturator internus emerges from Foramen obturatum, attaches to Fossa trochanterica. Turns the thigh out.
External Muscles
1. M. gluteus maximus starts from the lateral aspect of the Ilium and Sacrum, and ends at the Tuberositas glutea of the Femur. This is also called the great rough muscle. It acts on the hip joint and extends the thigh. If the thigh is stable, it pulls the torso back.
2. M. gluteus medius and minimus start from the lateral surfaces of the ilium and end at the trochanter, major of the femur. Both muscles abduct the thigh.
3. M. obturator externus and quadratus, femoris, For. It starts from the lateral surface of the obturatum and from the Memrana obturatoria, the second muscle tuber ischiadicum. Her iki kas femurun trochanter, major’ u, fossa trochanterca ve crista intertrochanterica’ da sonlanırlar. Bu kaslar femuru dışa döndürme ve adductor hareketleri yaptırırlar.
4. M. tensor fasciae latae, İlium’un spina iliaca anterior superior’ undan başlar ve femurun enli fasiyası üzerinde dağılarak sonlanır. Bu kas fasiyayı gerer.
Kas içi Enjeksiyon: Kas içine verilcek sıvı ilaçlar iskelet kaslarına enjekte edilirler. Enjeksiyon eylemine kasiçi enjeksiyon (İntra musculer; kısaca, IM) denir.
Kasiçi enjeksiyon uygulamada en çok gluteal kaslara yapılır. Bu kaslar M. gluteus maximus, M.gluteus medius ve M.gluteus minimus’ tur. Uygulama için hasta yüzü aşağıda yatar duruma getirilir. Gluteal bölge kabarıklığı göz kararıyla dikey kesişen iki çizgiyle dört bölüme ayrılır. Üst – dış bölümün ortasından iğne dikey biçimde batırılır ve sokulur. Bu bölüm, önemli sayılacak damar ve sinir olmadığı için yeğlenir.
Kas içi enjeksiyonda iğne kişinin kaba arıklık durumuna göre ortalama 2 – 4 cm batırılır. İğne yavaş yavaş itilir. Kas içi enjeksiyon hasta yatarken yapılmalıdır. Otururken ya da ayakta yapılması sakıncalar doğurabilir.
Uyluk Kasları
Uyluk kasları ön, arka ve iç yan kasları olarak üç gruba ayrılırlar.
Ön grup kaslar: M. quadriceps femoris, M. sartorius’ dur.
1. M. quadriceps femoris (uyluğun dört başlı kası), kuvvetli bir kastır. Dört parçası vardır. M. rectus femoris, M. vastus lateralis, M. vastus medialis ve M. vastus intermedius bölümlerinden oluşur. Rectus femoris parçası ilium’ un spina iliaca anterior superior’ unda vastus parçaları femur’ dan başlar. Aşağıda bu dört parça ortak bir krişte (tendo) yaparlar ve bu kiriş Patella kemiğinin üzerinden geçer, Tibia’ nın tuberositas tibae’ sında sonlanır. Kiriş Lig. patella adını alır. Bu bağa vurulduğunda özel bir refleks olur ve buna Patellar refleks denir. Bu kas diz eklemini etkiler ve bacağa ekstensiyon hareketi yaptırarak öne getirir.
2. M. sartorius, insan vücudunun en uzun kasıdır. Spina iliaca anterior superior’ dan başlar, eğik olarak aşağıya ve içe doğru uzarır, Tibia’ nın tuberositas tibiae’ sına yakın sonlanır. Diz eklemiyle bacağa fleksiyon yaptırır, büker ve arkaya götürür.
Arka grup kaslar: Üç kas vardır. M. semitendinosus, M. membranosus ve M. biceps femoris. Her üç kas Tuber ischiadicum’ dan başlar. M. semitendinosus ile M. semimembranosus tibia’ da, M. biceps femoris fibula’ da sonlanır. Arka grup kaslar diz eklemini etkilerler ve bacağa fleksiyon yaptırırlar. Diz eklemi fleksiyonda iken M.biceps femoris bacağı dışa diğer iki kas içe döndürür.
İçyan grup kaslar: Beş kas vardır. M. pectineus, M. gracilis ve üç adduktor kas (M. adductor longus, M. adductor brevis, M.adductor magnus). Bu kasların başlangıç yerleri pubis ve ischium kemikleridir. M. gracilis dışında hepsi Femur üzerinde sonlanır, M.gracilis ise Tibia’ da sonlanır. Hepsi kalça eklemine etki ederler ve uyluğa adduksiyon hareketi yaptırırlar. O nedenle bu kaslara Adduktor kaslar da denir.
Bacak Kasları
Bacak kasları ön, arka ve dış yan kasları olarak üç gruba ayrılırlar. Bütün kaslar ayağa uzarır.
Bacağın Ön Bölgesi Kasları, üç tanedir: M. tibialis anterior, M. extensor digitorum longus (ayağın) ve M. extensor hallucis longus. Bu kasların birincisi Tibia’ nın condylus lateralisinin ön yüzünden, diğer ikisi Tibia ve Fibula’ nın ön ve orta kısımlarından çıkarlar M. tiaialis anterior Os cuneiformia ve 1. metatarsal kemiğin plantar yüzüne, M. extensor digitorum longus dört tendoya ayrılarak 2.- 5. metatarsuslara, M. extensor hallucis longus ise baş parmağın distal phalanx’ına yapışır. Tibialis anterior ayağa fleksiyon, diğer iki kas parmaklara ekstensiyon yaptırır.
Arka grup kaslar, dört tanedir: M. triceps surae, M. tibialis posterior, M. flexor digitorum longus ve M. fIexor hallucis longus. M. triceps surae (Baldırın üçbaşlı kası) çok kuvvetli bir kastır. Bu kas iki kastan oluşur: M. gastrocnemius ve M. soleus. Gastrocnemius kasının iki parçası vardır (caput laterale ve caput mediale). Femurun condylus laterale ve medialisinden, M. soleus ise Tibia’ nın Linea muculi solei’ sinden çıkar. Bu iki kas ortak bir tendo yaparlar bu tendoya (Tendo calcaneus communis, yada tendo achillus) denir. Tendo topuk kemiğinin (Calcaneus) arka yüzünde sonlanır. Triceps surae kası ayak bileği eklemine etki ederek (Topuk) kaldırır ve kişinin parmakları üzerinde durmasını sağlar. Bu hareket ayağın ekstensiyonudur.
M. triceps surae’nin altında M. tibialis posterior, M.fIexor digitorum longus ve flexor hallucis longus kasları bulunur.
Bu kaslar iç, malleolus’ un arasından ayağa uzarırlar. M. tibialis posterior ayak tabanını arkaya büker ve ayağı içe döndürür, diğer iki kas parmakları alta büker.
M. Triceps Surae Klinik Bilgi :
1.Atletizmde koşuya çok hızlı başlarken Tendo calcaneus yırtılabilir. Tam kopmalarda M. triceps surae’ nin boyunun kısalmasına bağlı olarak baldır kabartısı belirli şekilde artar. Yürüme olanağı ortadan kalkar. Bacağın arka bölgesine yayılan kesin bir ağrı gelişir. Genellikle yırtık, insertio noktasının 3 cm. üstünde olur.
Yırtılma sonucunda ayak normalden çok fazla dorsifleksiyon yapabilir. Ancak bir dirence karşı ayağın Plantar fleksiyona getiremez.
2. Tendo calcaneus’ a bir refleks çekiciyle vurulması sonucunda M. triceps surae’ da bir seyirme görülür. Buna ayak bileği refleksi denir. Refleks merkezleri S1. ve S2. segmentlerdedir.
3. Devamlı yüksek topuklu ayakkabı giyen bayanlarda M.triceps surae kısalır. Eğer bu bayanlar düz topuklu ayakkabı giyerlerse, bacakta geçici bir ağrı olur.
4. Diz tam eksentensiyonda iken ayağın güçle dorsi flaksiyona getirildiği pozisyonlarda M. gastrrocnemius’un içbaşı yırtılabilir. Kas zayıf ve dejeneratif değişiklikler gösterir. Bu durum daha çok tenis’ te görüldüğü için buna Tenis bacağı denir.
5. M. gastrocnemius yalnızca bir tek kaynaktan (Aa. surales) kanını alan birkaç kastan biridir. Bunlar terminal arterlerdir ve anastomozlar yoktur. Eğer biri tıkanırsa, onun beslediği alan nekroza uğrar.
6. Tendo calcaneus’un altındaki bursa, uzun mesafe koşucularında balerinlerde iltihaplanarak şişebilir.
7. Ayakta dururken bacak ve ayağın venöz kanı özellikle M. triceps surae’ nın kasılmaları ile sağılma tarzında yukarıya pompalanır. Bu kas kasılınca kan derin venler içinde yukarıya doğru ilerler. Normalde derin venler ile yüzeyel venleri bağlayan venlerdeki kapakçıklar, yüzeyel venlere doğru kan akımı engellerler. Ancak bu kapakçıkların yetmezliği durumunda hidrostatik basınç ve M. triceps surae’ nın kasılma etkisi ile kan yüzeysel venlere geçer ve onları genişletir (Varikoz venler – varis denir).
8. M. plantaris’in uzun tendonu el kaslarının tendonları yerine implantasyon için kullanılabilir. Tendonun çıkarılması ile bir hareket bozukluğu olmaz.
9. Basketbolcular, 100 m koşucuları ve balerinlerde, ayağın çok aniden dorsiflaksiyon yaptığı pozisyonlarda M. plantaris’in tendonu kopabilir.
10. Bir masaya oturmuş bireyin bacağı serbest fleksiyonda iken Lig. patellae’ ya bir refleks çekici ile vurulursa, diz sıçrayarak ekstensiyon yapar. Buna patella refleksi denir. N. femoralis kesilerinde patella refleksi kaybolur.
Refleks merkezleri L2 – L3 – L4 M. spinalis segmenlerinde refleks kaybolur. Patella refleksi klinikte en çok muayene edilen bir reflekstir.
Dışyan grup kaslar, iki tanedir M. peroneus longus ve M. peroneus brevis. Caput fibulae ve fibula’ nın dış yüzünden çıkarlar. M. peroneus longus 1. metatarsal kemik ile os cuneiforme II’ ‘ye yapışır. M. peroneus brevis ise V. metatarsus’ a yapışır. Bunlar ayağı geriye bükerler ve dışa döndürürler. Çocuk felcinde bu grup kaslar etkilenirler.
Ayak Kasları
Ayak kasları ayak sırtı (dorsal) ve ayak tabanı (plantar) kasları olarak iki gruba ayrılırlar. Ayağın sırtında bir kas vardır, M. extensor digitorum brevis, kasın beş parmağa giden beş tendosu vardır. Ayak tabanındaki kaslar, içyan dışyan ve orta (ara) kaslar olarak üç gruba ayrılırlar. İç yan Kaslar : Üç tanedir. M. flexor hallucis brevis, M. abductor hallucis ve M. adductor hallucis. Dış yan kaslar: Üç tanedir. M. flexor digiti quinti brevis, M.abductor digiti quinti ve M.opponens digiti quintidir. Orta kaslar: M. flexor digitorum brevis, parmakları büker. Mm.lumbricales, dört tanedir; üst (proximal) falanksları büker. Mm. interodorsales, dört tanedir; parmaklara abduksiyon yaptırırlar. Mm. interossei plantares, üç tanedir, parmaklara adduksiyon yaptınrlar.
Ayak kasları aynı zamanda ayağın şeklini verirler.
Önemli Yerler ve Oluşumlar:
Trigonum femorale (Scarpa üçgeni ) : Üstten Lig. inguinale, dışından M. sartorius ve içyandan M. adductor longus’ un sınırlandığı üçgen alandır. Burada, uyluğun büyük kan damarları bulunur: A. ve V. femoralis, A. ve V. profunda femorisi, V. saphena magna’ nın uç parçası.
Canalis femoralis: Trigonum femorale bölgesi içinde bulunur. Lig. inguinale’nin içyan tarafındadır. Normalde bu kanal yoktur, ancak femoral fıtık olgularında şekillenir. İç organların kanal içinden uyluk derisi altına çıkmalarına femoral fıtık denir. Kanal 2 cm kadar uzunluktadır. Bunun duvarlarını fascia lata’nın iki tabakası ve V. femoralis yapar. Fascia lata, insan vücudunun en kuvvetli fasiyasıdır. Uyluktaki üç grup kas arasına bölmeler verir. Uyluğun ön yüzü üzerinde ve Lig. inguinale’nin altında fascia lata incedir. Fascianın bu kısmına Lamina cribrosa denir. Normalde fıtık yoktur. Burası bağdoku ve lenf damarıyla doldurulmuştur. Kanalın içyan ve dışyan olmak üzere iki deliği vardır. İçyan delik periton ve fascia tarafından kapatılmıştır. Dışyan delik fascia lataya açılır.
Fossa poplitea (Dizardı çukuru) : Fossa poplitea diz ekleminin arka yüzü üzerinde bulunur. Kenarlarını, M. semitendinosus’ un tendosu içten, M. biceps femoris’ in tendosu, dıştan ve alttan M. gastrocnemius’ un iki başı yapar. Bu çukurdaki büyük kan damarları (A. ve V. poplitea) ve sinirler (N. tibialis. N. peroneus communis), bağdoku içine gömülü olarak bulunurlar.
Sağlıklı günler dileği ile…
Uzman Dr.Ali AYYILDIZ – Veteriner Hekim – İnsan Anatomisi Uzmanı Dr.(Ph.D.)
