Posterior aspect of the thigh and the popliteal fossa Flashcards
Cutaneous Nerves of Posterior Thigh
Blue: Obturator nerve
Yellow: Medial femoral cutaneous nerve ( branch of femoral n)
Green: Posterior femoral cutaneous nerve
Pink: Lateral femoral cutaneous nerve
Hamstring-ischiocrural muscles
Semimembranosus
Biceps femoris
Semitendinosus
- Semitendinosus (half tendon)
- Bicep femoris
- Semimembranosus (half membrane)
- Gracilis
- Short head of bicep
- Bicep femoris (long head)
Hamstring avulsion.
What is it?
Cause?
How is it fixed?
Result?
When the hamstring muscle tendons are pulled powerfully from the ischial tuberosity (sometimes bone is pulled too with tendon or ligament).
- caused by a sudden contraction of hamstring muscle during exercise.
-requires surgery to reattach torn tendon to ischium.
- results in hematoma (blood clot in organ or tissue etc)
Semitendinosus muscle origin
Ischial tuberosity
Semitendinosus muscle insertion
Proximal end of tibia below medial condyle (via pes anserinus)
Semitendinosus muscle nerve
Tibial division of sciatic nerve
Pes anserinus muscles (say grace before tea)
- Sartorius (Femoral nerve)
- Gracilis (Obturator nerve)
- Semitendinosus (Tibila division of sciatic n)
Semitendinosus muscle function
Hip joint: thigh extension
Knee joint: Leg flexion
HAMSTRING GRAFT FOR ANTERIOR CRUCIATE LIGAMENT (ACL)REPAIR
The graft is taken from the hamstring tendon (semitendinosus) along inside of thigh and knee.
- small incision over hamstring tendon and graft is prepared from 2 tendons that are stripped off the muscle.
- Torn ACL removed and replaced.
Biceps femoris muscle origin
Long head: Ischial tuberosity
Short head: Lateral lip of linea aspera (same as vastus lateralis)
Biceps femoris muscle insertion
Fibular head (laterally) (Fibularis longus origin)
Biceps femoris muscle function
Hip joint: Thigh extension
Knee joint: Leg flexion
Biceps femoris muscle innervation
Long head: Tibial divison of sciatic nerve (L5-S2)
Short head: Common fibular divison of sciatic nerve. (L5-S2)
Right: Short head of bicep femoris m- linea aspera
Left: Long head of bicep femoris m - from ischial tuberosity
2 branches of sciatic nerve (YELLOW)
Common fibular nerve (right)
Tibial nerve (left)
Semimembranosus muscle origin
Ischial tuberosity
Semimembranosus muscle insertion
Medial condyle of tibia and forms oblique popliteal ligament
Semimembranosus muscle function
Hip joint: thigh extension
Knee joint: flexion and internal leg rotation
Semimembranosus muscle nerve
Tibial division of sciatic nerve (L5-S2)
Adductor magnus
Vastus lateralis
Semitendinosus
Bicep femoris
Semimembranosus
What are the muscles of posterior aspect of thigh
Hamstring m
Ischiocrural m
Muscles of posterior aspect of the thigh innervated by which nerve?
Tibial nerve except short head of bicep femoris
Function muscles of posterior aspect of the thigh
extension of hip and flexion of knee
Boundaries of popliteal fossa
Pink (medial): Semimembranosus
Green (lateral): Bicep femoris
Brown: Medial head of gastrocnemius
Orange: Lateral head of gastrocnemius
Blue: Plantaris
Boundaries of popliteal fossa (4 borders)
Pink (Superomedial): Semimembranosus
Green (Superolateral): Long head of Bicep femoris
Brown(Inferomedial): Medial head of gastrocnemius
Orange (Inferolateral): Lateral head of gastrocnemius
Blue (Inferolateral): Plantaris
Popliteal fossa
Diamond shaped depression posterior to knee joint.
- important n and v pass from thigh to leg through this fossa.
Floor of popliteal fossa (ant wall)
Tibia
Femur (popliteal surface)
Oblique popliteal ligament
Popliteus muscle and its own fascia
Right: Popliteal surface
Up left: Oblique popliteal ligament
Down left: Popliteus muscle
Roof of popliteal fossa (posterior wall)
Popliteal fascia and skin
Popliteal fascia is continues with fascia lata( leg)
Superficial layer of popliteal fascia
Fat
Small saphaneous vein
Cutaneous nerve
Deep layer of popliteal fascia
Strong, dense sheet
Protects neurovascular structures
Difficult to take pulse
Popliteal artery and its branches
Anterior tibial artery (medially)
Posterior tibial artery (laterally)
Popliteal artery is a continuation of
Femoral artery
How does popliteal artery enter popliteal fossa?
Passing under semimembranosus muscle
Popliteal artery location
between adductor hiatus and poplitieus muscle
runs close to articular capsule of knee joint
What arteries does the popliteal artery branch to form
Superior medial genicular a
Superior lateral genicular a
Middle genicular a
Inferior medial genicular a
Inferior lateral genicular a
- Descending branch of lateral circumflex femoral artery
- Lateral superior genicular a
- Lateral inferior genicular a
- Circumflex fibular a
- Descending genicular artery
- Medial superior genicular a
- Medial inferior genicular a
What will be damaged if femur is fractured?
Popliteal artery
Popliteal vein is continuation of
posterior tibial vein
Popliteal vein path
Posterior tibial vein–> Popliteal vein–> Superifical to popliteal artery–> Femoral vein (exits fossa superiorly and passes adductor hiatus)–> takes saphenous vein.
Where is popliteal vein formed?
Distal border of popliteus muscle (union of anterior and posterior tibial veins)
Brown: Lateral sural cutaneous nerve
Green: Superficial femoral nerve
Red: Sural nerve via lateral dorsal cutaneous branch
Yellow: Deep femoral nerve
How is sural nerve formed?
Union of:
Medial sural cutaneous nerve (branch of tibial nerve)
Ledial sural cutaneous nerve (branch of common fibular nerve)
What does the sural nerve (S1,S2) supply?
Lateral side of leg and ankle
Sural nerve biopsy
An incision is made, and the lesser saphenous vein is identified. The vein is then retracted superficially to expose the sural nerve.
Lateral malleolus is the landmark
Sural nerve biopsy results
Sensory deficit no motor deficits
Sural nerve biopsy makes you liable to
To be affected by neuropathy since its a distal branch of a long nerve.
Lymph nodes in popliteal fossa number
6-8
Lymph nodes in popliteal fossa 2 main groups
Superficial popliteal
Deep popliteal
Superficial popliteal lymph nodes
lie within subcutaneous tissue
-receive lymph from lymphatic vessels accompanying short saphenous vein.
- Small, in popliteal fat
Deep popliteal lymph nodes
-surround popliteal vessels
-recieve lymph from superficial popliteal lymph nodes as well as leg and foot.
-lymph drains into deep inguinal lymph nodes.
-recieve lymph from knee joint and lymphatic vessels.
Content of popliteal fossa (medially to laterally) (8)
Popliteal artery
Popliteal vein
Tibial nerve
Common fibular nerve
End branch of posterior femoral cutaneous nerve
Articular branch of obturator nerve
Popliteus bursa
Fat
- Popliteal a and v
- Tibial nerve
- Common fibular nerve
both branches of sciatic nerve - Posterior femoral cutaneous nerve
- Articular branch of obtuator nerve
Sciatic nerve pathway
Tibial nerve–> Medial sural cut. nerve
Common fibular nerve–> Lateral sural cut. nerve.
Between lat and medial–> communicating branch of sural nerve
Both form the sural nerve
Baker’s cyst
Synovial membrane of knee joint sometimes makes continuation with popliteal fossa called popliteal bursa.
If the knee joint swells the synovial fluid passes the popliteus bursa and can be seen as swelling behind the knee (Baker’s cyst)
If it remains can compress nerve.