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These different roles can be described as agonists (or prime movers), antagonists, or synergists. Medial border: Insertion of 3 muscles Mnemonic: SLR - all supplied by nerves from ROOT of brachial plexus Anteriorly: Serratus anterior (Long thoracic nerve) Posteriorly: Superiorly: Levator scapulae (Dorsal scapular nerve) Inferiorly: Rhomboids - minor superior to major (Dorsal scapular nerve) SLR and SIT mnemonic for scapular muscle attachment b. Teres Major. The muscle inserts on the medial part of the anterior border of the scapula. Muscle memory is a form of procedural memory that involves consolidating a specific motor task into memory through repetition, which has been used synonymously with motor learning. S: supraspinatus I: infraspinatus T: teres minor S: subscapularis With 'SITS', recalling this order also helps remember the insertions of these muscles, with the order being superior, middle, and inferior facets of the greater tubercle of the humerus for supraspinatus, infraspinatus and teres minor respectively and . It inserts into the 5th proximal phalanx (pinky finger). It is often grouped as one of the muscles of the arm due to its insertion, but its actions involve the shoulder portion only, this why it has been included in the shoulder section here. The muscles of facial expression originate from the surface of the skull or the fascia (connective tissue) of the face. An easy way to distinguish between the actions of the interossei is to use the following mnemonic. My origin is the inferior skull, spinous processes T1-6. Enrolling in a course lets you earn progress by passing quizzes and exams. Some axial muscles cross over to the appendicular skeleton. Memorizethe superficial forearm flexors usingthe followingmnemonic! It acts as an abductor of the shoulder, and inserts onto the superior facet of the greater tubercle of the humerus. From the sides and the back of the neck, the splenius capitis inserts onto the head region, and the splenius cervicis extends onto the cervical region. This article will discuss the anatomy of the serratus anterior muscle. Action: Actions Alone(unilateral), lateral flexion of vertebral column; Together (bilateral), depression of thoracic rib cage, any of the three pairs of muscles on each side of the neck that are involved in moving the neck, and in breathing remember this mnemonic: Aortic hiatus=12 letters =T12 Esophageal =10 letters= T10 Vena cava = 8 letters = T8 These final muscles make up your calf. Because the muscles insert in the skin rather than on bone, when they contract, the skin moves to create facial expression (Figure 11.4.1). Like the trapezius, this muscle can be divided into three sets of fibers: anterior, lateral, and posterior. Muscle Origin, Insertion, and Action - 1 by AshPopRox 4,509 plays 11 questions ~30 sec English 11p More 6 too few (you: not rated) Tries Unlimited [?] The middle fibers retract (adduct). This is a bony deformity of the finger or toes associated with rheumatoid arthritis and trauma to the end of the extended finger. This injury is commonly called baseball finger. The neurovascular bundle (intercostal nerve, artery and vein) will separate these two muscles. There are numerous muscles in this compartment. Extrinsic tongue muscles insert into the tongue from outside origins, and the intrinsic tongue muscles insert into the tongue from origins within it. It also acts as an extensor of the wrist and radial deviator. Tearing most commonly occurs in the tendon of supraspinatus. This compartment is posterior in anatomical position. The iliocostalis group includes the iliocostalis cervicis, the iliocostalis thoracis, and the iliocostalis lumborum. It inserts onto the ulnar aspect of the 5th proximal phalanx. Supraspinatus muscle:This rotator cuff muscle is deep and originates from the supraspinous fossa which is located on the posterior superior portion of the scapula. Biceps femoris, semitendinosus, and semimembranosus. Why are the muscles of the face different from typical skeletal muscle? The brevis muscle arises from the lateral epicondyle and inserts onto the dorsal base of the 3rd metacarpal. Origin: Clavicle, acromion process, spine of scapula Insertion: Deltoid tuberosity of the humerus Action: Abducts arm; flexes, extends, medially, and laterally rotates arm. The shoulder moves at the glenohumeral joint. origin: along spinus process of vertebrae and occipital bone It inserts onto the deltoid tuberosity, which is a roughened elevated patch found on the lateral surface of the humerus. It arises from the spinous processes of the T7-L5 (L = Lumbar) vertebrae, costals 8-12, inferior angle of the scapula, and iliac crest. As the muscles contract, they exert force on the bones, which help to support and move our body along with its appendages. There are several small facial muscles, one of which is the corrugator supercilii, which is the prime mover of the eyebrows. Origin: Clavicle, sternum, cartilages of ribs 1-7 Insertion: Crest of greater tubercle of humerus Action: flexes, adducts, and medially rotates arm, Origin: Clavicle, acromion process, spine of scapula Insertion: Deltoid tuberosity of the humerus Action: Abducts arm; flexes, extends, medially, and laterally rotates arm, Origin: thoracolumbar fascia Insertion: Intertubercular groove of humerus (spirals from your back under your arm) Action: adducts humerus (pulls shoulder back and down), Origin: Lateral border of scapula Insertion: Greater tubercle of humerus Action: Laterally rotates and adducts arm, stabilizes shoulder joint, Origin: Long head; superior margin of glenoid fossa Short Head; Coracoid process of scapula Insertion: Radial Tuberosity Action: Flexes arm, flexes forearm, supinates hand, Origin: Anterior, distal surface of humerus Insertion: coronoid process of ulna Action: Flexes forearm, Origin: Infraglenoid tuberosity of scapula, lateral and posterior surface of humerus Insertion: Olecranon process, tuberosity of ulna Action: Extends and adducts arm, extends forearm, Origin: Lateral supracondylar ridge of humerus Insertion: styloid process of radius Action: Flexes forearm, Origin: Symphysis Pubis (inferior ramus of pubis) The muscles of the back and neck that move the vertebral column are complex, overlapping, and can be divided into five groups. These include the digastric muscle, which has anterior and posterior bellies that work to elevate the hyoid bone and larynx when one swallows; it also depresses the mandible. | 15 You ride Longer on a Superhighway. It runs down the posterior compartment of the forearm and inserts into the middle and distal phalanges of the 2nd to 5th digits. For example, the biceps brachii performs flexion of the forearm as the forearm is moved. Mnemonics to recall the muscles of the rotator cuff are:. Origin: Flexor digitorum profundus (FDP) Insertion: Extensor hood on radial side (lateral bands) Function: Flex MCP joint and extend PIP joint Innervation. Depresses mandible when hyoid is fixed; elevates hyoid when mandible is fixed; Posterior belly; facial nerve Anterior belly mylohyoid nerve, Elevates and retracts hyoid; elongates floor of mouth, Elevates floor of mouth in initial stage of swallowing, Depresses mandible when hyoid; elevates and protracts hyoid when mandible is fixed, Depresses hyoid after it has been elevated, Depresses the hyoid during swallowing and speaking, Depresses hyoid; Elevates larynx when hyoid is fixed, Depresses larynx after it has been elevated in swallowing and vocalization, Temporal bone (mastoid process); occipital bone, Unilaterally tilts head up and to the opposite side; Bilaterally draws head forward and down, Occiput between the superior and inferior nuchal line, Extends and rotates the head to the opposite side, Posterior rami of middle cervical and thoracic nerves, Unilaterally and ipsilaterally flexes and rotates the head; Bilaterally extends head, Posterior margin of mastoid process and temporal bone, Extends and hyperextends head; flexes and rotates the head ipsilaterally, Dorsal rami of cervical and thoracic nerves (C6 to T4), Rotates and tilts head to the side; tilts head forward, Individually: rotates head to opposite side; bilaterally: flexion, Individually: laterally flexes and rotates head to same side; bilaterally: extension, Transverse and articular processes of cervical and thoracic vertebra, Rotates and tilts head to the side; tilts head backward, Spinous processes of cervical and thoracic vertebra. Similar to the erector spinae muscles, the semispinalis muscles in this group are named for the areas of the body with which they are associated. 1. Therefore, when they contract, the origin pulls the insertion and connected bone closer . Diaphragm *Note the distinction between internal and innermost intercostal. Muscle contraction results in different types of movement. In anatomical terminology, chewing is called mastication. Hypothenar eminence:It consists of the flexor digiti minimi brevis, the abductor digiti minimi brevis, and the opponens digiti minimi. lessons in math, English, science, history, and more. The lower fibersare responsible forelevation and depression. Resulting in the inability to straighten the digit. The erector spinae comprises the iliocostalis (laterally placed) group, the longissimus (intermediately placed) group, and the spinalis (medially placed) group. It is best studied broken down into its components: regions, joints, muscles, nerves, and blood vessels. Author: 1 / 24. It is innervated by the musculocutaneous nerve. It blends into the thoracolumbar fascia, which acts to stabilize the sacroiliac joints along with the gluteus maximus muscles. TABLE: Origin, Insertion, and Action for Lecture Checklist: Selected Human Muscles. In our cheat sheets, youll find the origin(s) and insertion(s) of every muscle. Take a look at the following two mnemonics! We will also discuss the clinical relevance of the upper limb. Registered Nurse, Free Care Plans, Free NCLEX Review, Nurse Salary, and much more. When a movement is repeated over time, the brain creates a long-term muscle memory for that task, eventually allowing it to be performed with little to no conscious . Semispinalis capitis: Origin: transverse processes of C7-T12. Our opposable thumb is essential to our advancement as a species. action: protraction of scapula, muscle that allows you to shrug your shoulders or extend your head There are a number of other joints in the region which all move in unison in order to generate a stable movement. As these attachments of the brachialis are similar in nature to those of the biceps brachii, so is its action. 2023 It acts as a lateral rotator and a weak adductor of the shoulder. Get instant access to this gallery, plus: Introduction to the musculoskeletal system, Nerves, vessels and lymphatics of the abdomen, Nerves, vessels and lymphatics of the pelvis, Infratemporal region and pterygopalatine fossa, Meninges, ventricular system and subarachnoid space, Anterior, medical and posterior thigh muscles, Anterior, lateral and posterior leg muscles, Thenar, hypothenar and metacarpal muscles of the hand, Muscles of facial expression and mastication. Injection Gone Wrong: Can You Spot The Mistakes? These muscles bring together the spinous and transverse processes of each consecutive vertebra. It is a powerful superficial muscle of the shoulder. The back muscles stabilize and move the vertebral column, and are grouped according to the lengths and direction of the fascicles. A skeletal muscle attaches to bone (or sometimes other muscles or tissues) at two or more places. Click the card to flip . At the end of this video, you will be able to: 20 chapters | 977 Cards -. Extensor carpi ulnaris muscle:This muscle arises from the lateral epicondyle and runs distally to insert onto the dorsal surface of the base of the 5th metacarpal and ulnar shaft. The triceps is the antagonist, and its action opposes that of the agonist. It commonly occurs following a fall onto an outstretched hand (FOSH). Here's a mnemonic to help you remember the innervation of the lumbricals more easily! Reviewer: Hip Muscles | Anatomy, Support & Movement, Pectoralis Major Action, Function, Insertion & Origin, Erector Spinae Action, Origin & Insertion | Iliocostalis, Longissimus & Spinalis, Teres Major Muscle Action, Origin & Insertion | Teres Major Location, Multifidus Muscle | Origin, Insertion & Action, Pectoralis Minor | Origin, Action & Insertion, Establishing Boundaries in Massage Therapy, Deltoid Muscle Action, Origin & Insertion | Deltoid Muscle Function. It acts to flex the elbow. It consists mainly of type 1 muscle fibers and hence provides sustained elbow extension. The information we provide is grounded on academic literature and peer-reviewed research. Flashcard Maker: sean bennet. There's a lot to learn about the anatomy of the upper limb muscles. This is where the rotator cuff muscles become inflamed and impinged as they pass through the subacromial space. Due to these attachments, contraction and muscle shortening of the biceps flexes the forearm. The muscle acts primarily as a supinator of the forearm, as well as a flexor of the elbow. Subjects: action comments insertion muscles nerve origin skeletal . Copyright Most of these movements are realized when we run. For . In addition, both muscles working together are the flexors of the head. laterally rotates the femur with hip extension, flexes humerus, antagonist of supraspinatus Action: Extends thigh, flexes leg, Narrower than semimembranosus Hamstring Anatomy Mnemonics - Origin, Insertion, Innervation & Action No views Aug 11, 2022 0 Dislike Share Save Memorize Medical 125 subscribers Easy ways to learn and remember the. These are unique muscles which originate from flexor tendon and insert into extensor tendon and act as guy ropes to correct tension between two opposing forces to maintain balance.. The layman will refer to the entire upper limb as the arm. The muscles are named after their functions, with the flexor muscle lateral most, the abductor medial most, and the opponens muscle lying deep. The transversospinales include the semispinalis capitis, semispinalis cervicis, semispinalis thoracis, multifidus, and rotatores. Muscles of the Upper Limb Pectoralis minor ORIGIN: anterior surface of ribs 3 - 5 ACTION INSERTION: coracoid process (scapula) Muscles Stabilizing Pectoral Girdle INNERVATION: pectoral nerves: protracts / depresses scapula (Anterior view) Serratus anterior ORIGIN: ribs 1 - 8 INSERTION: ACTION medial border of scapula stabilizes / depresses The second way to describe a muscle's action is based on the joint, or the articulation. The head is balanced, moved and rotated by the neck muscles (Table 11.5). It arises from the trapezium and transverse carpal ligament. Register now The first grouping of the axial muscles you will review includes the muscles of the head and neck, then you will review the muscles of the vertebral column, and finally you will review the oblique and rectus muscles. Posterior dislocation can occur in epileptics or electric shocks. insertion: spinus process of scapula These muscles are located inside the eye socket and cannot be seen on any part of the visible eyeball (Figure 11.4.3 and Table 11.3). It lays directly superficial to the flexor digitorum superficialis. Due to this arrangement the deltoid has a large area of origin: from the acromion, lateral superior portion of the clavicle, and lateral third of the scapular spine. The thyrohyoid muscle also elevates the larynxs thyroid cartilage, whereas the sternothyroid depresses it. They also contribute to deep inhalation. A synergist is a muscle that enhances the action of the agonist. It acts to pronate the forearm and weakly flex the elbow. Iliacus muscle. As the supraspinatus passes under the subacromial arch it is vulnerable to rupture from a bony spur. Tongue muscles can be extrinsic or intrinsic. It is caused by damage to the extensor tendon complex as it inserts onto the distal phalanx of any of the digits. Take advantage of the following mnemonic to make your life a little easier! The muscles are named after their functions, with the flexor muscle medial most, the abductor lateral most, and the opponens muscle lying deep. Origin: It is also innervated by the median nerve. Shahab Shahid MBBS We will use examples to describe how the origin and insertion affect the action of a skeletal muscle. 2009. All interossei are innervated by the deep branch of the ulnar nerve, which enters the palm through Guyons canal, a tunnel formed by the pisiform and hook of hamate. Action: external rotator of the thigh psoas major - origin : lumbar vertebrae It has three heads: long, lateral, and medial. Extensor carpi radialis longus and brevis muscles:The longus muscle arises from the lateral epicondylar ridge and inserts onto the dorsal surface of the 2nd metacarpal. The muscle arises mainly from the flexor retinaculum and tubercle of the trapezium and inserts onto the proximal phalanx or metacarpal of the thumb. The lateral head arises from the posterior surface of the humerus, above the radial groove of the humerus. Most skeletal muscles create movement by actions on the skeleton. Interossei:These are grouped into four dorsal and threepalmar interossei and are part of the midpalmar group. Groups of muscles are involved in most movements and names are used to describe the role of each muscle involved. The muscles of the anterior neck are arranged to facilitate swallowing and speech. Origin: Ischial tuberosity One common style of the Monteggia fracture is in children where the radial head is dislocated through a forceful pulling on the arm. This muscle divides the neck into anterior and posterior triangles when viewed from the side (Figure 11.4.8). The third group, the spinalis group, comprises the spinalis capitis (head region), the spinalis cervicis (cervical region), and the spinalis thoracis (thoracic region). Action: Extends thigh, flexes leg, Wider than semmitendonosis Avascular necrosis of the proximal segment is a common complication. The radial two lumbricals are innervated by the median nerve and the ulnar two are innervated by the ulnar nerve. Try refreshing the page, or contact customer support. Test your knowledge on the muscles of the arm right away using our handy round-up of quizzes, diagrams and free worksheets. Supinator muscle:It is a small muscle that arises from the lateral epicondyle of the humerus, the supinator crest of the ulna, as well as the annular and radial collateral ligaments that support the radius against the ulna. It is innervated by the anterior interosseous branch. Some of the axial muscles may seem to blur the boundaries because they cross over to the appendicular skeleton. Phew. Our muscle anatomy charts make it easier by listing them clearly and concisely. Have you triedour upper limb muscle anatomy revision chartyet? It arises from the flexor retinaculum, scaphoid tubercle, and trapezium. Conversely, you can say the elbow is proximal to the wrist. Last reviewed: July 22, 2022 Suprahyoid muscles are superior to it, and the infrahyoid muscles are located inferiorly. Agonists, or prime movers, are responsible for the bulk of the action. copyright 2003-2023 Study.com. If youve ever attempted to learn the origins, insertions, innervations, and functions of all 600+ muscles in the body youll know what a soul-destroying task it can be. 1 / 24. origin: cervical vertebrae EKG Rhythms | ECG Heart Rhythms Explained - Comprehensive NCLEX Review, Simple Anatomy Quiz Most Nurses Get WRONG! In this article we will discuss the gross (structure) and functional anatomy (movement) of the muscles of the upper limb. The splenius group includes the splenius capitis and the splenius cervicis. It also causes contributes to flexion of the proximal IP, MP, and wrist joints, although these are its secondary function. In addition, you might want to watch our anatomy and physiology lectures on YouTube, or check our anatomy and physiology notes. This muscle chart eBook covers the following regions: This eBook contains high-quality illustrations and validated information about each muscle. Tongue muscles are both extrinsic and intrinsic. The intrinsic muscles of the hand contain the origin and insertions within the carpal and metacarpal bones. inserion: medial border of scapula origin: anterior sacrum It has an essential role in initiating the first 15 degrees of abduction (move away from the body). Bone Tissue and the Skeletal System, Chapter 12. Definition. The actions and innervation are the same as the rhomboid major. Coracobrachialis muscle :The beauty of this muscle is that its name explains its origin, insertion, and action. It inserts into the medial aspect of the 5th metacarpal. PAD DAB ('Use your hand to dab with a pad'). The muscle has a frontal belly and an occipital belly (near the occipital bone on the posterior part of the skull). The movement of the eyeball is under the control of the extra ocular (extrinsic) eye muscles, which originate from the bones of the orbitand insert onto the outer surface of the white of the eye. It is the chief medial rotator of the shoulder and modulates the movement of the deltoid. Lumbricals:These are worm like muscles that originate from the tendons of the flexor digitorum profundus. Muscles of the Posterior Neck and the Back. Muscle Name or Group Origin Insertion Action. The humeroulnar head arises from the medial epicondyle and the radial head arises from the superior anterior surface of the radial shaft. Manifestations are limited movement of the shoulder and severe pain. The action makes sense when you consider the muscle's points of attachment. It controls extension, lateral flexion, and rotation of the vertebral column, and maintains the lumbar curve. The common flexor origin is the medial epicondyle. You walk Shorter to a street Corner. Palmaris longus muscle: This muscle can be absent in some of the population. Its like a teacher waved a magic wand and did the work for me. Click the card to flip . Insertion: greater trochanter on the back of the femur Copyright 2023 RegisteredNurseRN.com. The spinalis group includes the spinalis capitis, the spinalis cervicis, and the spinalis thoracis. insertion: mediar aspect of humerus, Origin posterior border of iliac crest All Rights Reserved. The muscle is innervated by the anterior interosseous branch. Stretching the muscle causes the triceps muscle to contract and, thus, slow flexion. I highly recommend you use this site! origin: neck Insertion: mastoid process of temporal bone, occipital bone. This mnemonic recalls the four intrinsic muscles of the hand innervated by the median nerve, whereas all the other intrinsic muscles are ulnar nerve: F: flexor pollicis brevis. The multifidus muscle of the lumbar region helps extend and laterally flex the vertebral column. If the place is a bone that remains immobile for an action, the attachment is called an origin. Test your knowledge on the muscles of the hand with the following quiz. The muscles of the neck are categorized according to their position relative to the hyoid bone (Figure 11.4.7). This also helps you understand its action (s) as well as what injuries may be present if there is pain in relevant areas. Rhomboid minor muscle:This is a smaller muscle with the same shape as the rhomboid major and lies above it. It is caused by proximal interphalangeal joint flexion, and distal interphalangeal joint extension. The scaphoid bone forms the floor of the anatomical snuffbox and articulates with the radius at the wrist. Last reviewed: November 03, 2021 It causes extension of the IP joints, the MP joints, and wrist. Extensor digitorum muscle:This muscle lies in the extensor compartment and arises from the lateral epicondyle. All the intrinsic muscles of hand are supplied by the deep . The nerve supply is from the long thoracic nerve, which arises from the C5, C6, and C7 nerve roots. Commonly referred to as impingement syndrome. There are numerous muscles in this compartment as well. Tap the Skeletal System Icon, and press the Plus button until you come to the Origin and Insertion layer (the fourth layers of the system). This system reflects the bones of the skeleton system, which are also arranged in this manner. When movement of a body part occurs, muscles work in groups rather than individually. Insertion: Head of fibula, lateral condyle of tibia The nerve supply comes from the upper and lower subscapular. The muscle has dual innervation. You'll find this conveniently illustrated on the cheat sheets. The occipitofrontalis muscle elevates the scalp and eyebrows. We strive for 100% accuracy, but nursing procedures and state laws are constantly changing. With these movements, you can feel the action of the corrugator supercilli. Youll be able to clearly visualize muscle locations and understand how they relate to surrounding structures. The Chemical Level of Organization, Chapter 3. Working together enhances a particular movement. In our cheat sheets, you'll find the origin (s) and insertion (s) of every muscle. Muscles involved in chewing must be able to exert enough pressure to bite through and then chew food before it is swallowed (Figure 11.4.4 and Table 11.4). It arises from the occipital bones, occipital protuberance and nuchal lines, as well as the spinous processes of C7 through T12. The acronym for the rotator cuff is S.I.T.S. Kinesiological Analysis: Description & Major Components, Massage Therapy Scope of Practice | Overview, Purpose & Manipulation. Triceps brachii muscle:This is the only muscle of the posterior compartment of the arm. 2. Gross Anatomy I. Bony Landmarks Types & Identification | What are Femur Landmarks? Due to this abducting movement, the supraspinatus is commonly referred to as the suitcase muscle; i.e. Muscles of the shoulder and upper limb can be divided into four groups: muscles that stabilize and position the pectoral girdle, muscles that move the arm, muscles that move the forearm, and muscles that move the wrists, hands, and fingers. Oftentimes, synergist muscles are needed to get a particular action started. The opponens digiti minimi arises from the hook of hamate and flexor retinaculum. The serratus anterior muscle originates from the 1st to 8th or 9th rib s and inserts at the anterior surface of the scapula. Don't forget to quiz yourself on the forearm flexors and extensors to consolidate your knowledge! Muscles of Face ----- skull----- skin of face----- facial expression Orbicularis oculi frontal and maxilla & tissue of eyelid closes eye ligaments around orbit For example, one could say the wrist is distal to the elbow. Sample Decks: Muscles Actions, Origins, and Insertions of the Pelvic Complex and Hip (week 5), The Structure of The Knee Joint (week 6), The Foot and Ankle (week 6) Show Class. It is innervated by the musculocutaneous nerve, a branch of the lateral cord of the brachial plexus. The particular movement is a direct result of the muscle attachment. The transversospinales muscles run from the transverse processes to the spinous processes of the vertebrae. The Cellular Level of Organization, Chapter 4. Learning anatomy is a massive undertaking, and we're here to help you pass with flying colours. The genioglossus depresses the tongue and moves it anteriorly; the styloglossus lifts the tongue and retracts it; the palatoglossus elevates the back of the tongue; and the hyoglossus depresses and flattens it. The origin is the attachment site that doesn't move during contraction, while the insertion is the attachment site that does move when the muscle contracts. They arise from the metacarpal bones and insert into the extensor hoods of each finger. The shoulder joint (glenohumeral joint) is an inherently unstable joint, and thus requires a significant degree of muscular support in the form of the rotator cuff. This deep muscle arises from the coracoid process of the scapula and inserts onto the medial surface of the humeral diaphysis (shaft). 'Rule of 3s' and 'Busy BeesCollaBorate well'. The triceps brachii becomes the agonist - while the biceps brachii is the antagonist - when we extend our forearm. L: lateral two lumbricals. Naming Skeletal Muscles | How are Muscles Named? Agonists and antagonists are always functional opposites. Its innervation is from the upper suprascapular nerve. The Cardiovascular System: Blood Vessels and Circulation, Chapter 21. The three muscles of the longissimus group are the longissimus capitis, associated with the head region; the longissimus cervicis, associated with the cervical region; and the longissimus thoracis, associated with the thoracic region.