Superior rectus muscle

Last updated
Superior rectus
Eye movements elevators.jpg
View of the eye from above, showing the action of the superior rectus muscle.
Details
Origin Annulus of Zinn at the orbital apex
Insertion 7.9 mm superior to the corneal limbus
Nerve Oculomotor nerve
Actions Elevation, adduction, intorsion
Identifiers
Latin musculus rectus superior bulbi
TA98 A15.2.07.010
TA2 2042
FMA 49035
Anatomical terms of muscle

The superior rectus muscle is a muscle in the orbit. It is one of the extraocular muscles. It is innervated by the superior division of the oculomotor nerve (III). In the primary position (looking straight ahead), its primary function is elevation, although it also contributes to intorsion and adduction. It is associated with a number of medical conditions, and may be weak, paralysed, overreactive, or even congenitally absent in some people.

Contents

The superior rectus muscles is shown in this image of the right eye from above. Hover the mouse over the structures for their names. Click for more information. Eye orbit anatomy superior.jpg IrisLimbus
The superior rectus muscles is shown in this image of the right eye from above. Hover the mouse over the structures for their names. Click for more information.

Structure

The superior rectus muscle originates from the annulus of Zinn. It inserts into the anterosuperior surface of the eye. This insertion has a width of around 11 mm. [1] It is around 8 mm from the corneal limbus. [1]

Nerve supply

The superior rectus muscle is supplied by the superior division of the ipsilateral oculomotor nerve (III). Each superior rectus muscle is innervated by contralateral oculomotor nucleus in the mesencephalon. [2]

Relations

The superior rectus muscle is related to the other extraocular muscles, particularly to the medial rectus muscle and the lateral rectus muscle. [3] The insertion of the superior rectus muscle is around 7.5 mm from the insertion of the medial rectus muscle, around 7.1 mm from the insertion of the lateral rectus muscle, and around 7.9 from the corneal limbus. [1] There is an intermuscular septum between it and the lateral rectus muscle. [3]

Variation

Variations of the superior rectus muscle is rare. [4] It may rarely have two muscle bellies parallel to each other. [4] More rarely, it may be congenitally absent. [5] [6]

Function

The superior rectus muscle elevates, adducts, and helps intort (rotate the superior pole of the eye medially) the eye.

Clinical significance

Testing

The superior rectus muscle is the only muscle that is capable of elevating the eye when it is in a fully abducted position. [7]

Exophthalmos

Much of the venous drainage of the orbit and the extraocular muscles passes close to the superior rectus muscle. [8] Obstruction to this venous drainage can cause venous congestion in the eye, which may cause exophthalmos (bulging eye ball). [9] This may be shown with CT scans. [8]

Weakness and paralysis

The superior rectus muscle may be weakened or paralysed by problems with nerve conduction of the oculomotor nerve (III). [9] This may be congenital, often with a familial genetic link, or acquired, most often caused by head injuries. [9]

Overreaction

Local anaesthetics used in cataract surgery may weaken the inferior rectus muscle, despite efforts to use minimal anaesthetic and to avoid placing the needle into the muscle. [10] Weakness of the inferior rectus muscle may strengthen the superior rectus muscle, causing it to be overreactive. [10] This may elevate the eye, and prevent its use in normal vision. [10] Treatment may involve eye surgery that weakens or repositions the superior rectus muscle, which generally has good outcomes. [10]

Absence

Very rarely, the superior rectus muscle may be congenitally absent. This may be caused by Apert syndrome. [5] This causes a reduced ability to elevate the eye. [6] It may be treated with eye surgery that uses parts of the medial rectus muscle and the lateral rectus muscle to restore the functions normally performed by the superior rectus muscle. [6]

Additional images

Related Research Articles

<span class="mw-page-title-main">Abducens nerve</span> Cranial nerve VI, for eye movements

The abducens nerve or abducent nerve, also known as the sixth cranial nerve, cranial nerve VI, or simply CN VI, is a cranial nerve in humans and various other animals that controls the movement of the lateral rectus muscle, one of the extraocular muscles responsible for outward gaze. It is a somatic efferent nerve.

<span class="mw-page-title-main">Oculomotor nerve</span> Cranial nerve III, for eye movements

The oculomotor nerve, also known as the third cranial nerve, cranial nerve III, or simply CN III, is a cranial nerve that enters the orbit through the superior orbital fissure and innervates extraocular muscles that enable most movements of the eye and that raise the eyelid. The nerve also contains fibers that innervate the intrinsic eye muscles that enable pupillary constriction and accommodation. The oculomotor nerve is derived from the basal plate of the embryonic midbrain. Cranial nerves IV and VI also participate in control of eye movement.

<span class="mw-page-title-main">Orbit (anatomy)</span> Cavity or socket of the skull in which the eye and its appendages are situated

In anatomy, the orbit is the cavity or socket/hole of the skull in which the eye and its appendages are situated. "Orbit" can refer to the bony socket, or it can also be used to imply the contents. In the adult human, the volume of the orbit is 30 millilitres, of which the eye occupies 6.5 ml. The orbital contents comprise the eye, the orbital and retrobulbar fascia, extraocular muscles, cranial nerves II, III, IV, V, and VI, blood vessels, fat, the lacrimal gland with its sac and duct, the eyelids, medial and lateral palpebral ligaments, cheek ligaments, the suspensory ligament, septum, ciliary ganglion and short ciliary nerves.

<span class="mw-page-title-main">Superior oblique muscle</span> Part of the eye

The superior oblique muscle or obliquus oculi superior is a fusiform muscle originating in the upper, medial side of the orbit which abducts, depresses and internally rotates the eye. It is the only extraocular muscle innervated by the trochlear nerve.

<span class="mw-page-title-main">Levator scapulae muscle</span> Slender skeletal muscle at the back and side of the neck

The levator scapulae is a slender skeletal muscle situated at the back and side of the neck. It originates from the transverse processes of the four uppermost cervical vertebrae; it inserts onto the upper portion of the medial border of the scapula. It is innervated by the cervical nerves C3-C4, and frequently also by the dorsal scapular nerve. As the Latin name suggests, its main function is to lift the scapula.

<span class="mw-page-title-main">Eye movement</span> Movement of the eyes

Eye movement includes the voluntary or involuntary movement of the eyes. Eye movements are used by a number of organisms to fixate, inspect and track visual objects of interests. A special type of eye movement, rapid eye movement, occurs during REM sleep.

<span class="mw-page-title-main">Levator palpebrae superioris muscle</span> Muscle in orbit that elevates upper eyelid

The levator palpebrae superioris is the muscle in the orbit that elevates the upper eyelid.

<span class="mw-page-title-main">Inferior rectus muscle</span>

The inferior rectus muscle is a muscle in the orbit near the eye. It is one of the four recti muscles in the group of extraocular muscles. It originates from the common tendinous ring, and inserts into the anteroinferior surface of the eye. It depresses the eye (downwards).

<span class="mw-page-title-main">Lateral rectus muscle</span> Muscle on lateral side of the eye

The lateral rectus muscle is a muscle on the lateral side of the eye in the orbit. It is one of six extraocular muscles that control the movements of the eye. The lateral rectus muscle is responsible for lateral movement of the eyeball, specifically abduction. Abduction describes the movement of the eye away from the midline, allowing the eyeball to move horizontally in the lateral direction, bringing the pupil away from the midline of the body.

<span class="mw-page-title-main">Medial rectus muscle</span> Extraocular muscle that rotates the eye medially

The medial rectus muscle is a muscle in the orbit near the eye. It is one of the extraocular muscles. It originates from the common tendinous ring, and inserts into the anteromedial surface of the eye. It is supplied by the inferior division of the oculomotor nerve (III). It rotates the eye medially (adduction).

<span class="mw-page-title-main">Inferior oblique muscle</span> Part of the eye

The inferior oblique muscle or obliquus oculi inferior is a thin, narrow muscle placed near the anterior margin of the floor of the orbit. The inferior oblique is one of the extraocular muscles, and is attached to the maxillary bone (origin) and the posterior, inferior, lateral surface of the eye (insertion). The inferior oblique is innervated by the inferior branch of the oculomotor nerve.

<span class="mw-page-title-main">Extraocular muscles</span> Seven extrinsic muscles of the eye

The extraocular muscles, or extrinsic ocular muscles, are the seven extrinsic muscles of the eye in humans and other animals. Six of the extraocular muscles, the four recti muscles, and the superior and inferior oblique muscles, control movement of the eye. The other muscle, the levator palpebrae superioris, controls eyelid elevation. The actions of the six muscles responsible for eye movement depend on the position of the eye at the time of muscle contraction.

<span class="mw-page-title-main">Abducens nucleus</span>

The abducens nucleus is the originating nucleus from which the abducens nerve (VI) emerges—a cranial nerve nucleus. This nucleus is located beneath the fourth ventricle in the caudal portion of the pons near the midline, medial to the sulcus limitans.

<span class="mw-page-title-main">Common tendinous ring</span> Ring of fibrous tissue around optic nerve at its entrance to the eye

The common tendinous ring, also known as the annulus of Zinn or annular tendon, is a ring of fibrous tissue surrounding the optic nerve at its entrance at the apex of the orbit. It is the common origin of the four recti muscles of the group of extraocular muscles.

<span class="mw-page-title-main">Ophthalmic nerve</span> Sensory nerve of the face

The ophthalmic nerve (CN V1) is a sensory nerve of the head. It is one of three divisions of the trigeminal nerve (CN V), a cranial nerve. It has three major branches which provide sensory innervation to the eye, and the skin of the upper face and anterior scalp, as well as other structures of the head.

<span class="mw-page-title-main">Nasociliary nerve</span> Branch of the ophthalmic nerve

The nasociliary nerve is a branch of the ophthalmic nerve (CN V1) (which is in turn a branch of the trigeminal nerve (CN V)). It is intermediate in size between the other two branches of the ophthalmic nerve, the frontal nerve and lacrimal nerve.

<span class="mw-page-title-main">Sixth nerve palsy</span> Medical condition

Sixth nerve palsy, or abducens nerve palsy, is a disorder associated with dysfunction of cranial nerve VI, which is responsible for causing contraction of the lateral rectus muscle to abduct the eye. The inability of an eye to turn outward, results in a convergent strabismus or esotropia of which the primary symptom is diplopia in which the two images appear side-by-side. Thus, the diplopia is horizontal and worse in the distance. Diplopia is also increased on looking to the affected side and is partly caused by overaction of the medial rectus on the unaffected side as it tries to provide the extra innervation to the affected lateral rectus. These two muscles are synergists or "yoke muscles" as both attempt to move the eye over to the left or right. The condition is commonly unilateral but can also occur bilaterally.

<span class="mw-page-title-main">Superior ophthalmic vein</span> Vein of the orbit around the eye

The superior ophthalmic vein is a vein of the orbit that drains venous blood from structures of the upper orbit. It is formed by the union of the angular vein, and supraorbital vein. It passes backwards within the orbit alongside the ophthalmic artery, then exits the orbit through the superior orbital fissure to drain into the cavernous sinus.

<span class="mw-page-title-main">Oculomotor nerve palsy</span> Medical condition

Oculomotor nerve palsy or oculomotor neuropathy is an eye condition resulting from damage to the third cranial nerve or a branch thereof. As the name suggests, the oculomotor nerve supplies the majority of the muscles controlling eye movements. Damage to this nerve will result in an inability to move the eye normally. The nerve also supplies the upper eyelid muscle and is accompanied by parasympathetic fibers innervating the muscles responsible for pupil constriction. The limitations of eye movement resulting from the condition are generally so severe that patients are often unable to maintain normal eye alignment when gazing straight ahead, leading to strabismus and, as a consequence, double vision (diplopia).

The term gaze is frequently used in physiology to describe coordinated motion of the eyes and neck. The lateral gaze is controlled by the paramedian pontine reticular formation (PPRF). The vertical gaze is controlled by the rostral interstitial nucleus of medial longitudinal fasciculus and the interstitial nucleus of Cajal.

References

  1. 1 2 3 Apt, L (1980). "An anatomical reevaluation of rectus muscle insertions". Transactions of the American Ophthalmological Society. 78: 365–375. ISSN   0065-9533. PMC   1312149 . PMID   7257065.
  2. Anderson, B.C.; McLoon, L.K. (2010), "Cranial Nerves and Autonomic Innervation in the Orbit", Encyclopedia of the Eye, Elsevier, pp. 537–548, doi:10.1016/b978-0-12-374203-2.00285-2, ISBN   978-0-12-374203-2 , retrieved 2023-02-02
  3. 1 2 Nam, Yong Seok; Park, Yooyeon; Kim, In-Beom; Shin, Sun Young (2019-07-10). "Detailed Anatomy of the Lateral Rectus Muscle-Superior Rectus Muscle Band". Journal of Ophthalmology. 2019: e5374628. doi: 10.1155/2019/5374628 . ISSN   2090-004X. PMC   6652029 . PMID   31360544.
  4. 1 2 Nayak, Satheesha B.; Shetty, Surekha D.; Kumar, Naveen; Aithal, Ashwini P. (2019-06-01). "Double-bellied superior rectus muscle". Surgical and Radiologic Anatomy. 41 (6): 713–715. doi:10.1007/s00276-019-02211-0. ISSN   1279-8517. PMID   30847519. S2CID   71147157.
  5. 1 2 Cuttone, James M.; Brazis, Peter J.; Miller, Marilyn T.; Folk, Eugene R. (1979-11-01). "Absence of the Superior Rectus Muscle in Apert's Syndrome". Journal of Pediatric Ophthalmology & Strabismus. 16 (6): 349–354. doi:10.3928/0191-3913-19791101-04. PMID   521875.
  6. 1 2 3 Mather, Thomas R.; Saunders, Richard A. (1987-11-01). "Congenital Absence of the Superior Rectus Muscle: A Case Report". Journal of Pediatric Ophthalmology & Strabismus. 24 (6): 291–295. doi:10.3928/0191-3913-19871101-06. PMID   3320326.
  7. "Eye Theory". Cim.ucdavis.edu. Retrieved 2012-12-02.
  8. 1 2 Hudson, Henry L.; Levin, Lori; Feldon, Steven E. (1991-10-01). "Graves Exophthalmos Unrelated to Extraocular Muscle Enlargement: Superior Rectus Muscle Inflammation May Induce Venous Obstruction". Ophthalmology. 98 (10): 1495–1499. doi:10.1016/S0161-6420(91)32099-2. ISSN   0161-6420. PMID   1961633.
  9. 1 2 3 White, James Watson (1933). "Paralysis of the Superior Rectus Muscle". Transactions of the American Ophthalmological Society. 31: 551–584. ISSN   0065-9533. PMC   1315454 . PMID   16692992.
  10. 1 2 3 4 Grimmett, Michael R.; Lambert, Scott R. (1992-07-01). "Superior Rectus Muscle Overaction After Cataract Extraction". American Journal of Ophthalmology. 114 (1): 72–80. doi:10.1016/S0002-9394(14)77415-X. ISSN   0002-9394. PMID   1621788.