Posterior Thigh and Popliteal Fossa Flashcards
Posterior Thigh muscles in general: Common proximal Attachment
Ischial Tuberosity
except for the short head biceps femoris
Posterior Thigh muscles in general: Common innervation
Tibial division of sciatic nerve
except short head of biceps femoris
Posterior Thigh muscles in general: Common functions
Leg flexion at knee
Thigh extension at hip (except short head of biceps femoris)
Semitendinosus Muscle
orgin: Ischial Tuberosity
Insertion: anteromedial aspect of superior tibia (pes anserinus
Function: extend the thigh and flex the leg
also medially rotate flexed leg
inn: Tibial division of Sciatic N
Pes anserinus
3 fingered conjoined tendon (anterior to posterior) Sartorius M Gracilis M Semitendinosus M
insertion from each three compartments
Pes Anserine Bursitis
Inflammation of the anserine bursa which is located between the Pes anserinus and the MCL
constant aching pain, aggrevated by activity specifically flexion and internal/medial rotation of the knee
Semimembranosus M
Long flat membranous tendon at proximal attachment
Orgin: ischial tuberosity
insertion: Posterior part of the medial tibial condyle
Function: Extend thigh and flex the leg also can medially rotate flexed leg
inn: Tibial division of sciatic N
Semiomembranosus distal tendon divisions
distal tendon divides into two main parts:
Medial tibial condyle (muscle attachment)
Oblique popliteal ligament: reinforce the intercondylar portion of knee joint capsule, forms part of the popliteal fossa floor
Biceps Femoris Muscle: Long head
Orgin: ischial tuberosity
insertion: Lateral aspect of the fibular head
Function: Extend thigh, flex leg, and laterally rotate flexed leg
Innervation: Tibial division of sciatic N
Biceps femoris Muscle: short head
Orgin: lateral lip of linea aspera and lateral supracondylar line
Insertion: Lateral aspect of fibular head
Function: Flex leg and laterally rotate flexed leg
Innervation: Common fibular division of sciatic N
Adductor Magnus muscle hamstring portion
Orgin: ischial tuberosity
Insertion: adductor tubercle on medial condyle
Function: Extend thigh
Innervation: Tibial division of sciatic N
Hamstring Injury: Grade 1
muscle strain or tear
can involve avulsion fractures from the ischial tuberosity
Mild
Small disruption in structural integrity
minor swelling
no or minimal loss of strength
Hamstring Injury: Grade 2
Muscle strain or tear
can involve avulsion fractures from the ischial tuberosity
Moderate
Partial tears with some intact muscle fibers
pain present
definite loss of strength
Hamstring Injury: Grade 3
Severe
complete tear
swelling, severe pain and typically with accompanied hematoma
complete loss of motor function
What supplies the posterior thigh muscles
the three perforating branches and terminal deep femoral arteries
also supplies Adductor magnus M
Descending branch of lateral femoral circumflex artery
Descends anterior thigh
supplies the genicular anastomosis
Descending Genicular Artery
arises from the femoral artery
branches out of the anteriomedial muscular septum with the saphenous N
supplies the genicular anastomosis
What drains the posterior thigh?
Deep femoral Vein
What innervates the skin of the posterior thigh
Posterior femoral cutaneous nerve
S1-S3
Sciatic nerve rami components that innervate the muscles
even though tibial division of the sciatic nerve is L4-S3
and the Common fibular division of the sciatic nerve is L4-S2
the muscles of the posterior thigh recieve innervation from L5-S2
except Hamstring portion of adductor magnus which gets L4 of the tibial division of the sciatic Nerve
Popliteal Fossa Boundaries: Superiorly
Superior medially: Semimembranosus and the semitendinosus
Superior laterally: Biceps femoris m
make up the superior angle of the fossa
Popliteal Fossa Boundaries: Inferiorly
Inferiorly medially: Medial head of the gastrocnemius m
Inferiorly laterally: Lateral head of the gastrocnemius m
Popliteal fossa boundaries: Floor
Popliteal surface of femur
Oblique popliteal ligament (from semimembranosus tendon)
Posterior surface of proximal tibia
Popliteal Fosssa Contents
Superficial to deep:
Nerves
Popliteal vein, branches and lymph nodes
Popliteal artery and branches
What does the popliteal artery terminate into
Anterior Tibial Artery
Posterior tibial artery
the popliteal artery also gives rise to the genicular branches
Genicular Anastamosis
these bypass the popliteal artery
supplies the articular capsule and ligaments of the knee joint
Superior lateral genicular artery Superior medial genicular artery Middle genicular artery (in joint capsule) Inferior Lateral genicular artery Inferior medial genicular artery
the inferior tend to be below the heads of the gastrocnemius heads
Genicular anastamosis blood supply
Popliteal artery
Descending branch of the lateral femoral circumflex artery
Descending genicular artery from the saphenous branch and the articular branch
Popliteal vein
formed by union of anterior and posterior tibial veins, usually near inferior border of popliteus muscle
termination point of saphenous vein
becomes femoral vein after traversing the adductor hiatus
Where does the sciatic nerve usually end and what does it turn into
Sciatic nerve ends at the superior angle of the popliteal fossa
turns into the Tibial Nerve and the common fibular nerve
Tibial Nerve
larger component of the sciatic nerve
descends centrally through popliteal fossa
Innervates the posterior leg muscles, knee joints, skin on posterior leg as the medial sural cutaneous nerve
Common fibular nerve
descends obliquely on lateral side of popliteal fossa medial to biceps femoris
winds around the head and neck of the fibula and is susceptible to injury
Innervates: anterior leg muscles via the deep fibular nerve
Lateral leg muscles via the superficial fibular nerve
skin on posterolateral leg via the lateral sural cutaneous nerve
Sural Nerve
cutaneous nerve of posterior leg and lateral aspect of ankle and foot
runs with small saphenous vein
composed of medial sural cutaneous nerve from tibial nerve and sural communicating branch from the common fibular or lateral sureal cutaneous nerve
Metaphyseal fractures
Distal femoral fracture
transverse fracture accross the shaft
most common distal femoral fracture
occurs at metaphysis
Physeal fractures
distal femoral fracture
transverse fracture involving the epiphyseal plate
commonly described by salter harris classification
Posterior displacement of distal femoral fractures can lead to?
neurovasculature issues due to close proximity to femur in the popliteal fossa
Vascular injury: Swelling in popliteal space, absent posterior tibial or dorsalis pedis pulses, slow distal capillary refill, cold pale feet
Nerve injury: Motor injury with foot drop, sensory deficits to dorsal pr plantar foot
Acute compartment syndrome
Increased pressure to a closed fascial compartment
due to hemorrhage and or edema
persistent deep ache or burning pain
paresthesia
pain with passive stretch
muscle weakness
Popliteal (Bakers) cysts
swelling of the popliteal fossa due to enlargement of the gastrocnemius semimembranosus bursa
contain synovial fluid
associated with degenerative and inflammatory joint disease
mostly asymptomatic
Peripheral Aneurysm
localized enlargement of an artery due to weakening of arterial wall
Popliteal artery aneurysms is a common one
may present with: claudication or ischemic pain at rest
sensory/motor nerve deficit
severe pain behind the knee
Peripheral Artery disease
Atherosclerosis
lack of blood flow leads to pain in affected muscle groups
may present with: Claudication Ischemic pain at rest severe diffuse pain nonhealing ulcer gangrene
