17. Posterior Thigh and Popliteal Fossa

Fascia of the Popliteal Fossa Superficial Structures - Small ____ vein - ____ ____ nerve of thigh - Medial ____ cutaneous nerve - Lateral ____ cutaneous nerve

Fascia of the Popliteal Fossa Superficial Structures - Small saphenous vein - Posterior cutaneous nerve of thigh - Medial sural cutaneous nerve - Lateral sural cutaneous nerve

The gluteal region and the thigh compartments are supplied by nerves from the lumbosacral plexus General innervation pattern in the thigh: • Anterior compartment = ____ nerve • Medial compartment = ____ nerve • Posterior compartment = ____ nerve Innervation to the gluteal region • ____ and ____ ____ nerves

The gluteal region and the thigh compartments are supplied by nerves from the lumbosacral plexus General innervation pattern in the thigh: • Anterior compartment = femoral nerve • Medial compartment = obturator nerve • Posterior compartment = sciatic nerve Innervation to the gluteal region • Superior and inferior gluteal nerves

The neurovascular structures passing through the popliteal fossa are arranged superficial to deep as follows: ____ → ____ → ____

The neurovascular structures passing through the popliteal fossa are arranged superficial to deep as follows: nerves → veins → arteries

Describe the four muscles that make up the posterior compartment of the thigh Describe which three muscles are considered hamstring muscles

The posterior compartment of the thigh consists of four muscles - Semitendinosus* - Semimembranosus* - Biceps femoris long head* - Biceps femoris short head Highlighted muscles are considered hamstring muscles

The sciatic nerve will bifurcate into the ____ nerve and ____ ____ nerve --> the bifurcation usually occurs prior to the ____ fossa

The sciatic nerve will bifurcate into the tibial nerve and common fibular nerve --> the bifurcation usually occurs prior to the popliteal fossa

The sural nerve is formed via the branching of the ____ and ____ ____ nerve together

The sural nerve is formed via the branching of the tibial and common fibular nerve together

There is no artery running vertically through the posterior compartment of the thigh The blood supply is via ____ arteries branching off of the ____ ____ artery (aka ____ artery of the thigh)

There is no artery running vertically through the posterior compartment of the thigh The blood supply is via perforating arteries branching off of the profunda femoris artery (aka deep artery of the thigh) Note: when you see horizontal arteries of the thigh they are most likely the perforating arteries

Thigh Compartments The thigh muscles are separated into three compartments Anterior - ____ leg at knee joint - ____ thigh at hip joint Medial - ____ thigh Posterior - ____ leg at knee joint - ____ thigh at hip joint

Thigh Compartments The thigh muscles are separated into three compartments Anterior - Extend leg at knee joint - Flex thigh at hip joint Medial - Adduct thigh Posterior - Flex leg at knee joint - Extend thigh at hip joint

Three of these muscles are hamstring muscles - Biceps femoris (LH), semitendinosus, and semimembranosus Hamstrings criteria* - Proximal attachment to the ____ ____ - Span and act on two joints (producing ____ at the ____ joint and ____ at ____ joint) - Innervation by the ____ division of sciatic nerve (L5, S1, S2

Three of these muscles are hamstring muscles - Biceps femoris (LH), semitendinosus, and semimembranosus Hamstrings criteria* - Proximal attachment to the ischial tuberosity - Span and act on two joints (producing extension at hip joint and flexion at knee joint) - Innervation by the tibial division of sciatic nerve (L5, S1, S2

Clinical Applications - Popliteal Fossa Injury to the tibial nerve in the popliteal fossa is uncommon because of its deep and protected position in the popliteal fossa. Can be injured by the following mechanisms: • Deep lacerations of the fossa • ____ dislocation of the knee joint • _____ artery ____ causing ____ on the nerve Clinical presentation would include: • ____ of the ____ muscles in the leg and intrinsic muscles in the ____ of the foot. • Patients would have weakened ____ at their ankle and ____ of the toes. • Loss of sensation would also occur on the ____ of the foot.

Clinical Applications - Popliteal Fossa Injury to the tibial nerve in the popliteal fossa is uncommon because of its deep and protected position in the popliteal fossa. Can be injured by the following mechanisms: • Deep lacerations of the fossa • Posterior dislocation of the knee joint • Popliteal artery aneurysm causing compression on the nerve Clinical presentation would include: • Paralysis of the flexor muscles in the leg and intrinsic muscles in the sole of the foot. • Patients would have weakened plantarflexion at their ankle and flexion of the toes. • Loss of sensation would also occur on the sole of the foot.

Contents of the Popliteal Fossa Contents - Small ____ vein - ____ artery and ____ vein - ____ and ____ ____ nerve - ____ ____ nerve of thigh - Popliteal lymph nodes and lymphatic vessels

Contents of the Popliteal Fossa Contents - Small saphenous vein - Popliteal artery and popliteal vein - Tibial and common fibular nerve - Posterior cutaneous nerve of thigh - Popliteal lymph nodes and lymphatic vessels Note: black arrow is pointing to the popliteal vein

Deep Boundaries of the Popliteal Fossa Superior border - Medial (1) and lateral (2) ____ ____ of the femur Inferior border - ____ line of the tibia (3) Floor - Popliteal surface of the femur - Joint capsule of the knee - Investing popliteus fascia

Deep Boundaries of the Popliteal Fossa Superior border - Medial (1) and lateral (2) supracondylar lines of the femur Inferior border - Soleal line of the tibia (3) Floor - Popliteal surface of the femur - Joint capsule of the knee - Investing popliteus fascia

From the following cross section, inferior view of the right thigh, identify the following: - semitendinosus - semimembranosus - biceps femoris LH - biceps femoris SH - profunda femorus artery and veins - sciatic nerve

From the following cross section, inferior view of the right thigh, identify the following: - semitendinosus - semimembranosus - biceps femoris LH - biceps femoris SH - profunda femorus artery and veins - sciatic nerve

From the following cross section, inferior view of the right thigh, identify the following: - semitendinosus - semimembranosus - biceps femoris LH - biceps femoris SH - profunda femorus artery and veins - sciatic nerve

From the following cross section, inferior view of the right thigh, identify the following: - semitendinosus - semimembranosus - biceps femoris LH - biceps femoris SH - profunda femorus artery and veins - sciatic nerve Answer on next card

Nerves in the Popliteal Fossa Tibial nerve (1) - Muscular branches to the posterior compartment of the leg - Medial sural cutaneous nerve (3) Common fibular nerve (2) - Lateral sural cutaneous nerve - Sural communicating branch (4) Sural nerve (5) - Medial sural cutaneous nerve and sural communicating branch form the sural nerve (the level of this formation is highly variable) Posterior cutaneous nerve of the thigh

Nerves in the Popliteal Fossa Tibial nerve (1) - Muscular branches to the posterior compartment of the leg - Medial sural cutaneous nerve (3) Common fibular nerve (2) - Lateral sural cutaneous nerve - Sural communicating branch (4) Sural nerve (5) - Medial sural cutaneous nerve and sural communicating branch form the sural nerve (the level of this formation is highly variable) Posterior cutaneous nerve of the thigh

Biceps Femoris Attachments Proximal - Long Head: ischial tuberosity - Short Head: ____ ____ and ____ line of femur Distal - head of ____ Innervation • Long Head: tibial division of sciatic nerve (L5, S1, S2) • Short Head: ____ division of sciatic nerve (L5, S1, S2 Main Action • Rotates leg ____ when knee is flexed; extends thigh

Biceps Femoris Attachments Proximal - Long Head: ischial tuberosity - Short Head: linea aspera and supracondylar line of femur Distal - head of fibula Innervation • Long Head: tibial division of sciatic nerve (L5, S1, S2) • Short Head: common fibular division of sciatic nerve (L5, S1, S2 Main Action • Rotates leg laterally when knee is flexed; extends thigh

Clinical Applications - Popliteal Fossa The popliteal artery and vein are in close proximity and confined within the fossa - They may form ____ ____ • Possible loss of leg and foot Popliteal Aneurysm - An aneurysm can cause edema and pain in the fossa. Will have a palpable pulse and will hear ____ during auscultation.

Clinical Applications - Popliteal Fossa The popliteal artery and vein are in close proximity and confined within the fossa - They may form arteriovenous fistula • Possible loss of leg and foot Popliteal Aneurysm - An aneurysm can cause edema and pain in the fossa. Will have a palpable pulse and will hear bruits during auscultation. note: Arteriovenous fistula = opening between the popliteal artery and vein (because they're located so close to each other at times a fistula between the two can occur) note: Bruits are vascular sounds resembling heart murmurs. Sometimes they're described as blowing sounds

Clinical Applications - Popliteal Fossa The popliteal fascia overlying the fossa is strong and resistant to _____ - _____ and _____ tend to be very painful and typically spread _____ and _____ because of the thickness of the popliteal fossa

Clinical Applications - Popliteal Fossa The popliteal fascia overlying the fossa is strong and resistant to expansion - Tumors and abscesses tend to be very painful and typically spread superiorly and inferiorly because of the thickness of the popliteal fossa

Popliteal vein Continuation of the ____ ____ vein, lies ____ to the popliteal artery and is in the same fibrous sheath, superiorly becomes the ____ vein once it passes through the ____ ____

Popliteal vein Continuation of the posterior tibial vein, lies superficial to the popliteal artery and is in the same fibrous sheath, superiorly becomes the femoral vein once it passes through the adductor hiatus

Semitendinosus Attachments • Proximal - ischial tuberosity • Distal - ____ surface of the ____ part of the ____ (called the ____ ____) Innervation • Tibial division of the sciatic nerve (L5, S1, S2) Main Action • Extends the hip, flexes the knee and rotates the knee ____

Semitendinosus Attachments • Proximal - ischial tuberosity • Distal - medial surface of the superior part of the tibia (called the pes anserinus) Innervation • Tibial division of the sciatic nerve (L5, S1, S2) Main Action • Extends the hip, flexes the knee and rotates the knee medially

Popliteal artery Continuation of the _____ artery and begins once it passes through the _____ _____ Gives off 5 genicular arteries At the inferior border of the of the popliteus muscle, it divides into the _____ and _____ _____ arteries

Popliteal artery Continuation of the femoral artery and begins once it passes through the adductor hiatus Gives off 5 genicular arteries At the inferior border of the of the popliteus muscle, it divides into the anterior and posterior tibial arteries

Semimembranosus Attachments • Proximal - ischial tuberosity • Distal - ____ tibial ____ , ____ ____ ligament, popliteus fascia Innervation • Tibial division of the sciatic nerve (L5, S1, S2) Main Action • Extends the hip, flexes the knee and rotates it ____

Semimembranosus Attachments • Proximal - ischial tuberosity • Distal - medial tibial condyle, oblique popliteal ligament, popliteus fascia Innervation • Tibial division of the sciatic nerve (L5, S1, S2) Main Action • Extends the hip, flexes the knee and rotates it medially

Superficial Boundaries of the Popliteal Fossa Superior border - Superolaterally: ____ ____ (6) - Superomedially: ____ (1) and ____ (2) Inferior border - Lateral head of the ____ muscle (5) - Medial head of the ____ muscle (3) Roof - Skin and popliteal fascia

Superficial Boundaries of the Popliteal Fossa Superior border - Superolaterally: biceps femoris (6) - Superomedially: semimembranosus (1) and semitendinosus (2) Inferior border - Lateral head of the gastrocnemius muscle (5) - Medial head of the gastrocnemius muscle (3) Roof - Skin and popliteal fascia