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MSK 2 > Posterior Thigh & Popliteal Fossa > Flashcards

Posterior Thigh & Popliteal Fossa Flashcards

1
Q

What are the 3.5 muscles of the posterior thigh?

A

Hamstrings

  1. Semitendinosus
  2. Semimembranosus
  3. Biceps Femoris: long head and short head
  4. 5: Adductor Magnus, hamstring portion
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2
Q

What structure can you identify for the anterior tibia?

A

Tibial tuberosity (location of pes anserinus)

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3
Q

What is the common proximal origin of the posterior thigh muscles?

A

Ischial tuberosity

-Except short head biceps femoris “odd ball”: lateral sipracondylar line and line aspera

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4
Q

Common innervation of posterior thigh ms?

A

Tibial division of sciatic n

-Except short head biceps femoris “odd ball”: common fibular division of sciatic n

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5
Q

Common functions of posterior thigh ms?

A
  • Leg flexion @ knee
  • Thigh extension @ hip (EXCEPT short head BF m)
  • Slightly medially rotate flexed leg
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6
Q

What is the distinguishing part of the semitendinosus muscle?

A

long cord like tendon that starts 2/3 way down thigh and inserts on Pes anserinus

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7
Q

What is the Pes Anserinus and what muscles contribute?

A
  • 3 fingered conjoining tendon
    1. Sartorius (anterior, femoral n.)
    2. Gracilis (medial, obturator n.)
    3. Semitendinosus (tibial division of sciatic n)

-superficial to MCL

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8
Q

Pes Anserine Bursitis

A
  • Inflammation of Anserine bursa between Pes anserinus and MCL (overuse or trauma)
  • Result in consistent, aching pain aggravated by activity (specifically flexion and internal rotation of knee)
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9
Q

What 2 parts does the distal semimembranosus m tendon divide into?

A
  1. Medial tibial condyle (muscle attachment)

2. Oblique popliteal l

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10
Q

Oblique popliteal l

A
  • Tendon of semimembranosus m
  • Reinforces intercondylar portion of knee joint capsule
  • Forms part of popliteal fossa floor
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11
Q

Generally what is a hamstring injury?

A
  • Muscle strain or tear, but also hamstring tendinopathy

- Can involve avulsion fractures from ischial tuberosity

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12
Q

What is a grade 1 - mild hamstring injury?

A
  • Small disruption in structural integrity
  • minor swelling and pain
  • no or minimal loss of strength
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13
Q

What is a grade 2 - moderate hamstring injury?

A
  • partial tear with some intact muscle fibers
  • pain present
  • definite loss of strength
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14
Q

What is a grade 3 - severe hamstring injury?

A
  • complete tear
  • swelling, severe pain and typically accompanied by hematoma
  • complete loss of motor function
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15
Q

When does the external iliac a change to the femoral a?

A

After it goes under the inguinal l.

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16
Q

When does the femoral a change to the popliteal a?

A

once it goes through the adductor hiatus

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17
Q

What muscle does the perforating branches of the deep femoral a go through?

A

adductor Magnus

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18
Q

Which nerves and nerve roots innervate the Biceps Femoris m?

A

Short head “odd”: common fibular division of sciatic n.
Long head: tibial division of sciatic n
Both L5-S2

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19
Q

What is the nerve root for the fibular division of sciatic n?

A

L4-S3

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20
Q

What is the nerve root for the Tibial division of sciatic n?

A

L4-S2

21
Q

What is the superomedial boundary of the popliteal fossa?

A

semimebranosus and semitendinosus

22
Q

What is the superolateral boundary of the popliteal fossa?

A

biceps femoris

23
Q

What is the inferolateral boundary of the popliteal fossa?

A

lateral head of gastrocnemius

24
Q

What is the inferomedial boundary of the popliteal fossa?

A

medial head of gastrocnemius

25
Q

What makes up the floor of the popliteal fossa?

A
  • oblique surface of femur
  • oblique popliteal l.
  • posterior surface of proximal tibia
26
Q

How are arteries, veins, lymph nodes, and nerves organized in the popliteal fossa?

A

Superficial: Nerves
Intermediate: popliteal vein, branches, and lymph nodes
Deep: popliteal artery and branches

27
Q

What are the nerves found in the popliteal fossa?

A

common fibular n and tibial n.

28
Q

What veins are found in the popliteal fossa?

A
  1. small saphenous v.
  2. popliteal v. (union of anterior and posterior tibial v. near inferior border)
    - superficial and same fibrous sheath as popliteal a.
29
Q

What lymph nodes are found in the popliteal fossa?

A

review this

30
Q

What arteries are found in the popliteal fossa?

A

popliteal a. with all branches (deepest structure in popliteal fossa)

31
Q

What structure differentiates the superior and inferior genicular arteries?

A

medial and lateral heads of the gastrocnemius

32
Q

What artery runs closely to distal femur that makes it an extra concern regarding injury?

A

popliteal a

33
Q

Metaphyseal fracture of the femur

A
  • transverse fracture across shaft

- most common distal femur fracture

34
Q

Physeal fracture of the femur

A
  • Commonly described as “Salter-Harris” Classification (1-5 types)
  • Transverse fracture involving epiphyseal plate: layers involved range between (growth plate, metaphysic, epiphysis) or crush injury of growth plate
35
Q

What would be the presentation indicating vascular injury from a distal femoral fracture?

A
  • swelling of popliteal space
  • absent/diminished dorsals pedis or posterior tibial pulses
  • slow, distal cap refill
  • Cole, pale feet
36
Q

What would be the presentation indicating nerve injury from a distal femoral fracture?

A
  • motor injury w/ foot drop

- sensory deficits to dorsal or plantar foot

37
Q

What would be a serious complication to distal femur fractures?

A

acute compartment syndrome

38
Q

What are the cause and presentation of acute compartment syndrome from a femur fracture?

A
  • increased pressure within closed fascial compartment
  • most commonly from hemorrhage and/or edema
  • Symptoms: persistent deep ache/burning pain, paresthesia, pain with passive stretch, muscle weakness
39
Q

Popliteal (Baker’s) cyst

A
  • swelling in popliteal fossa due to enlargement of gastrocnemius-semimebranosus bursa
  • associated with degenerative and inflammatory joint disease/injury
  • mostly asymptomatic
40
Q

What is the presentation of a popliteal baker’s cyst enlargement?

A
  • Simulates DVT
  • erythema
  • edema due to vein compression
  • ischemia due to arterial compression
  • nerve entrapment
  • positive Homan’s sign
41
Q

What is the presentation of a popliteal baker’s cyst rupture?

A
  • simulates thrombosis or muscle rupture
  • warmth, tenderness, erythema
  • ecchymoses
  • compartment syndrome
  • may cause little to no pain and just edema
42
Q

What is a peripheral aneurysm?

A
  • localized arterial enlargement due to weakened arterial wall
  • popliteal are most common
43
Q

Why are popliteal arteries the most common true peripheral arteries?

A

they involve all 3 layers of vessel wall

44
Q

What are symptoms of a peripheral aneurysm?

A
  • claudication or ischemic pain at rest
  • sensory/motor deficit
  • severe pain behind knee
45
Q

What is peripheral artery disease?

A

Atherosclerosis (cholesterol build-up) leading to peripheral artery occlusion
-leads to lack of blood flow and pain to affected muscles

46
Q

What is the clinical presentation of peripheral artery disease?

A
  • Claudication (pain)
  • ischemic pain at rest
  • severe diffuse pain
  • nonhealing ulcer
  • gangrene
47
Q

What are the consequences of injury to sciatic n?

A

…

48
Q

What arteries are involved in the genicular anastomosis?

A
  1. Lateral femoral circumflex a, descending branch
  2. Descending genicular a.: including saphenous and articular branches
  3. Superior and inferior lateral genicular as
  4. Superior and inferior medial genicular as
  5. Middle genicular a

MSK 2 (6 decks)

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