Organization: Fascia, Compartments, Spaces, and Relationships in the Lower Extremity and Back

Question 1

Posterior Compartment of the Thigh

Boundaries
Muscles
Blood Supply
Nerves

Answer 1

Formed by the posterior intermuscular septum of the thigh, the femur, the lateral intermuscular septum of the thigh, and the fascia lata

Muscles:
Contains the Hip Extensors and Knee Flexors; this compartment has less muscle bulk and is significantly smaller than the other thigh compartments

Blood Supply:
Perforating branches of Profundus Femoris; these branches pierce through the adductor magnus muscle and enter the posterior compartment of the thigh; there are 4 perforating branches - 3 branch off of the profunda femoris and one of them is the termination of profunda femoris

Nerves:
Motor: Sciatic Nerve; tibial division of the sciatic nerve supplies all of the muscles of the posterior thigh except the short head of biceps femoris

Sensory: Posterior Femoral Cutaneous Nerve

**Supplied by Sacral Plexus (L4 - S4)

Question 2

Obturator Foramen

Boundaries
Contents

Answer 2

Boundaries: Large oval aperture in the hip bone formed by the ramus of the ischium and the superior and inferior rami of the pubis. It is closed by the obturator membrane

Contents: The obturator membrane has an aperture called the obturator canal through which the obturator nerve, artery, and vein traverse to get to the medial thigh

Question 3

Fascia Lata

Boundaries
Apertures
Projections and Thickenings

Answer 3

Anteriorly, it begins at the level of the inguinal ligament, pubis, and iliac crest.

Posteriorly, it runs form the sacrum, coccyx, and sacrotuberous ligament to the ischial tuberosity

Inferiorly it is continuous with the crural fascia of the leg

It wraps around the whole though

It has an opening called the SAPHENOUS OPENING where the great saphenous vein comes out to run superficially. This opening is located just below the inguinal ligament a few inches lateral to the pubic tubercle.

It gives off 3 intermuscular septa (lateral, medial, and posterior) that project inwardly towards the femur separating the compartments of the thigh.

It has a lateral thickening called the iliotibial tract which attaches to gerdy’s tubercle on the tibia

Question 4

Anterior Thigh

Boundaries
Muscles
Arteries
Nerves

Answer 4

Boundaries: Fascia Lata, Lateral Intermuscular Septum, Femur, Medial Intermuscular Septum

Contents:
Muscles: Hip Flexors, Knee Extensors,

Arteries: Femoral Artery and Profunda Femoris (and branches)

Nerves: Femoral nerve (nerve to vastus medialis, saphenous nerve, and anterior femoral cutaneous nerve), Lateral femoral cutaneous nerve

**Most vascular and neural structures of the thigh run between the medial and anterior compartments of the thigh

**Supplied by Lumbar Plexus (L1-L4)

Question 5

Medial Thigh

Boundaries
Muscles
Arteries
Nerves

Answer 5

Boundaries: Fasica Lata, medial intermuscular septum, femur, lateral intermuscular septum

Contents:
Muscles: Hip adductors

Arteries: Obturator artery

Nerves: Obturator Nerve (anterior and posterior branches)

**Most vascular and neural structures of the thigh run between the medial and anterior compartments of the thigh

Question 6

Popliteal Fossa

Boundaries
Contents (Sarah Tastes Carmel Popcorn with Vines and Licorice)

Answer 6

Boundaries:
Roof: Skin, Fascia
Floor: Oblique popliteal ligament (extension of the tendon of semimembranosus), Popliteal Fascia, Femur
Superolateral: Biceps Femoris
Superomedial: Semimembranosus and Semitendinosus
Inferolateral: Lateral Head Gastrocnemius
Inferomedial: Medial Head Gastrocnemius

Contents:
Small Saphenous Vein
Tibial Nerve
Common Fibular Nerve
Popliteal Artery
Popliteal Vein
Lymph Nodes and Vessels

Question 7

Femoral Triangle

Boundaries
Contents (NAVEL)

Answer 7

Boundaries:
Roof: Skin, Fascia Lata, subcutaneous tissue
Floor: Pectineus, Iliopsoas, 
Superior: Inguinal Ligament
Medial: Adductor Longus
Lateral: Sartorius 

Contents:
Femoral Nerve (most medial)
Femoral Artery
Femoral Vein
Femoral Canal

**Artery, Vein, and Empty space lymphatics are enclosed in a femoral sheath

**Femoral canal contains “empty space lymphatics,” and allows for expansion of the artery and vein as blood passes through

Question 8

Adductor Canal

Alternate Name
Boundaries
Contents

Answer 8

AKA Subsartorial Canal

Boundaries:
Anterior and lateral - Vastus medialis
Anterior and Medial - Sartorius
Posterior - Adductor Longus and Adductor Magnus

Contents: Saphenous Nerve, Nerve to Vastus Medialis Femoral Artery, Femoral Vein

Question 9

Crural Fascia

Region
Boundaries
Projections and Thickenings

Answer 9

Deep Fascia of the Leg

Boundaries:
Superiorly continuous with the fascia lata of the thigh
Attaches to the medial and anterior borders of the tibia and to the patella
Inferiorly continuous with the deep fascia of the foot

Forms the Retinacula around the ankle inferiorly (Superior Extensor, Inferior Extensor, Superior Fibular, Inferior Fibular, Flexor) **inferior fibular retinaculum is continuous anteriorly with the inferior extensor retinaculum

Gives off 3 intermuscular septa:
Anterior and Posterior septa project inward to the margins of the fibula.
Transverse septum runs fromt he deep surface of the crural fasica to the posterior septum, dividing the posterior compartment of the leg into superficial and deep layers. **The neurovascular structures of the posterior leg run just deep to to the transverse intermuscular septum

Question 10

Anterior Compartment of the Leg

Boundaries
Muscles
Arteries
Nerves

Answer 10

Boundaries:
Tibia, Crural Fascia, Anterior Intermuscular Septum, Fibula, Interosseous Membrane

Contents:
Muscles - Ankle Dorsiflexors, Toe Extensors
Nerve - Deep Fibular Nerve
Artery: Anterior Tibial Artery

Question 11

Lateral Compartment of the leg

Boundaries
Muscles
Arteries
Nerves

Answer 11

Boundaries:
Crural Fascia, Anterior intermuscular septum, Fibula, Posterior Intermuscular Septum

Contents
Muscles: foot everters
Arteries: Perforating branches of Anterior Tibial Artery
Nerves: Superficial Fibular Nerve

Question 12

Posterior Compartment of the Leg

Boundaries
Muscles
Arteries
Nerves

Answer 12

Boundaries:
Superficial Layer - Crural Fascia, transverse intermuscular septum, posterior intermuscular septum
Deep Layer - Transverse intermuscular septum, tibia, interosseous membrane, fibula

Contents:
Muscles: Plantar flexors, Toe Flexors
Nerves: Tibial Nerve
Arteries: Posterior Tibial Artery and Fibular Artery

Question 13

Structures Passing Superficial to the Retinacula of the Ankle

Answer 13

Anteriorly:
Superficial Fibular Nerve

Medially:
Great Saphenous Vein, Saphenous Nerve

Laterally:
Small Saphenous Vein, Sural Nerve

Question 14

Structures Passing Deep to the Superior and Inferoir Extensor Retinacula

Tom ANd Harry’s Dog

Answer 14

Tibialis Anterior
Anterior Tibial Artery
Deep Fibular Nerve
Extensor Hallucis Longus
Extensor Digitorum Longus

Question 15

Structures Passing Deep to the Fibular Retinacula

Answer 15

Fibularis Longus

Fibularis Brevis

Question 16

Structures Passing Deep to the Flexor Retinaculum

Tom Dick ANd Harry

Answer 16

Tibialis Posterior
Flexor Digitorum Longus
Posterior Tibial Artery
Tibial Nerve
Flexor Hallucis Longus

Question 17

Superficial Plantar Fascia

Structure

Answer 17

Firous septa of the superficial fascia separate the lobulated fat pads of the sole of the foot. THese septa anchor the skin to the underlying CT to improve the grip of the sole of the foot

It is superficial to the plantar aponeurosis

Question 18

Deep Fascia of the Foot - Plantar Surface

Boundaries
Divisions
Pantar Aponeurosis
Septa

Answer 18

Boundaries: Continuous laterally with the deep fascia of the dorsum of the foot and proximally with the retinacula derived from the crural fascia of the leg.

Divisions:
Medial Plantar overlies the muscles of the hallux
Lateral Plantar overlies the muscles of the 5th digit

Septa:
Medial: separates out the muscles of the GT
Lateral: separates out the muscles of the 5th digit

Plantar Aponeurosis:
Centrally Located; continuous with the dorsal fascia via the medial and lateral fascia

Overlies the Long Flexor Tendons

Distally, forms 5 longitudinal bands that become continuous with the fibrous digital sheaths of the digits

Question 19

Dorsal Fascia of the Foot

Layers

Answer 19

Thin Deep Layer

Thin Superficial Layer

**Morse space so this is where swelling accumulates

Question 20

Fascia of the Digits of the foot

Plantar
Dorsal

Answer 20

Plantar:
The digits have plantar digital sheaths that old the tendons of the long flexors in place. They are continuous with the plantar aponeurosis.

Dorsal:
Extensor Expansions - analogous to the extensor expansions in the hand

Question 21

Suboccipital Triangle

Answer 21

Boundaries:
Superomedial - Rectus Capitis Posterior Major
Superolateral - Obliquus Capitis Superior
Inferior - Obliquus Capitis Inferior

Contents:
Vertebral Artery
Suboccipital Nerve (Dorsal Ramus C1 Spinal Nerve)