Posterior Thigh and Popliteal Fossa

Question 1

Biceps Femoris

Answer 1

Origin:
1. Long head: ischial Tuberosity
2. Short Head: lateral lip of linea aspera

Insertion:
1. head of fibula

Action:
1. Knee flexion
2. Lateral rotation
3. Hip extension (long head)

Innervation:
1. Short head: common peroneal nerve L5-S2
2. Long head: tibial Nerve L5-S2

Question 2

Semimembranosus

Answer 2

Origin:
1. Ischial Tuberosity

Insertion:
1. posterior medial tibial condyle

Action:
1. knee Flexion
2. Hip extension
3. knee medial rotation
4. hip medial rotation

Innervation
1. Tibial L5-S2

Question 3

Semitendinosus

Answer 3

Origin:
1. ischial tuberosity

Insertion:
1. Pes Anserinus

Action:
1. Hip medial rotation
2. knee medial rotation
3. knee flexion
4. hip extension

Innervation:
1. Tibial L5-S2

Question 4

Pes Anserinus

Answer 4

• sartorius
• Gracilis
• Semitendinosus

Question 5

Popliteal Fossa

Answer 5

Border:

• Semimembranosus/semitendinosus
• biceps femoris
• medial head gastrocneumis
• lateral head gastrocnemius

Contents:

• popliteal artery
• popliteal vein
• tibial nerve
• common fibular/peroneal nerve

Question 6

Sciatic nerve

Answer 6

• L4-S3
• anterior and posterior division of sacral plexus
• emerges into the posterior leg through the greater sciatic foramen

Question 7

Common Peroneal N

Answer 7

• L4-S2
• posterior division of sacral plexus
• innervates short head of biceps femoris

Question 8

Tibial Nerve

Answer 8

• L4-S3
• Anterior division of sacral pleuxus
• descends through popliteal fossa deep to the soleus

Question 9

Posterior femoral cutaneous

Answer 9

• S1-S3
• sensory innervation to posterior thigh and buttock

Question 10

Nerve Entrapment

Hamstring Syndrome

Answer 10

• sciatic nerve compression between 2 of the 3 hamistring muscles
• more common in individuals that play sports involving running, jumping, and kicking
• causes pain to hip and buttock
• sometimes causes paresthesia down back of leg

Question 11

Nerve Entrapments

Tibial Nerve entrapment

Answer 11

• nerve gets entrapped by the insertion sit of the soleus
• hypertrophy or swelling of the soleus muscle
• severe pain and tenderness present in the popliteal fossa
• can cause symptoms similar to S1 Radiculopathy

Question 12

Referral patterns in the posterior thigh

Answer 12

• Common causes: trigger points, lumbar spine S1-S2
• visceral structures: lower GI, bladder, kidney, uterus

Question 13

Slump test

Answer 13

• pt is seated with slumped posture and puts chin to chest with Over pressure
• pt actively extends one knee
• active DF with over pressure
• pt slowly releases neck flexion
• This test is performed to differentiate if posterior thigh pain is due to neurological structures of the spine or a hamstring injury

Question 14

Hamstring length test

Answer 14

• 90/90
• SLR
• WIth SLR therapist can dorsiflex them and invert and evert to distinguisg muscles

Question 15

Hamstring Strain

Answer 15

• extremely common with athletes
• 12% of all injuries in soccer league
• 180 hamstring injuries across 30 NFL teams each year
• type 1 and type 2

Question 16

Types of Hamstring strains

Answer 16

• Type 1= sprinting/load related
• type 2 = stretch related

Question 17

Hamstring strain

clinical presentation

Answer 17

• difficulty running/walking
• sudden onset
• reduced stretch
• bruising/tenderness
• slump test is negative

Question 18

Hamstring strain

Treatment

Answer 18

• acute: PRICE
• subacute: stretching, strengthening

Question 19

Hamstring strain

Recovery

Answer 19

• Depends on severity of strain
• mild straing = approximately 18 days

Question 20

Piriformis syndrome

Answer 20

• caused by compression of the piriformis muscle on the sciatic nerve which travels don the posterior leg

Question 21

Piriformis syndrome

causes and treatments

Answer 21

Causes:

• hypertrophy
• overuse
• trauma
• gender Women>men

Treatment:

• gentle pain free stretching
• STM
• Ice/ice massage