Lecture 09. Popliteal Fossa. BY Dr Farooq Khan Aurakzai

Transcription

1 Lecture 09 Popliteal Fossa BY Dr Farooq Khan Aurakzai Dated:

2 What is popliteus? Introduction Anything relating to, or near the part of the leg behind the knee. From New Latin popliteus the muscle behind the knee joint. So the depression behind the knee is called the POPLITEAL FOSSA.

3 Location: The Popliteal fossa is a space or shallow depression located at the back of the knee-joint. The bones of the popliteal fossa are the femur and the tibia. It is an important area of transition b/w the thigh and leg and is a major route by which structure pass from one region to another.

4 Boundaries: The following are the boundaries of the fossa: Superiolaterally: The bicep femoris. Superiomedially: The Semitendinosus and the Semomembranosus, supplemented by the gracilis, sartorius and adductor magnus muscles. Inferolaterally: Lateral head of the gastrocnemius supplemented by plantaris InferoMedially: Medial head of gastrocnemius.

5 Roof The roof of the fossa is formed by deep fascia or popliteal fascia: (From superficial to deep): 1. Skin. 2. Superficial fascia which contains 3. Short saphenous vein. 4. Three cutaneous nerves i.e, a. Terminal branch of posterior cutaneous nerve of thigh, b. Posterior division of medial cutaneous nerve, and c. peroneal or sural communicating nerve.

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7 Floor.. The floor of the fossa is formed by: a. The popliteal surface of femur b. Capsule of knee joint and the oblique Popliteal ligament c. strong fascia covering the Popliteal muscle

8 Contents The popliteal fossa houses: popliteal artery: A continuation of the femoral artery.lies deepest in the fossa. popliteal vein: Which lies in between the artery and the nerve. Tibial nerve and Common peroneal nerve Which lies most superficial, and therefore amenable to nerve block. Six or seven popliteal lymph nodes, embedded in the fat

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10 popliteal artery: It is the extension of the "superficial" femoral artery after passing through the adductor canal and adductor hiatus above the knee. The termination of the popliteal artery is its bifurcation into the Anterior Tibial artery and Posterior Tibial artery. The popliteal artery, through numerous smaller branches, supplies blood to the knee joint and muscles in the thigh and calf. It is accompanied, along its length, by the popliteal vein.

11 Relation of the Artery The popliteal artery while passing in the fossa it moves from medial to lateral side, so the relation is as follows: Superiorly: (Medial to lateral) A, V, N. Middle portion: (Superficial to deep) N, V, A Inferiorly: (Medial to lateral) N, V, A. The tibial nerve is the most superficial structure. The vain is in the middle. While the artery lies deepest.

12 The branches of the popliteal artery are: Posterior Tibial Anterior Tibial Muscular branches (Upper and lower) Medial superior Genicular artery Lateral superior Genicular artery Medial inferior Genicular artery Lateral inferior Genicular artery Middle Genicular artery Cutaneous Branches The Genicular arteries are five in number. The MGA supplies the cruciate ligaments and the synovial membrane of the knee joint. All the above four Genicular arteries participate on the anterior aspect of the knee joint. Upper Muscular branches supplies the hamstrings and adductor magus, while the lower branches supplies the Gastrocnemius, plantaris and soleus.

13 popliteal Vein The popliteal vein course runs alongside the popliteal artery but carries the blood from the knee joint and muscles in the thigh and calf back to the heart. Its origin is defined by the junction of the posterior tibial vein and anterior tibial vein. It drains the peroneal vein before reaching the knee joint and turns into the femoral vein when leaving the adductor canal. It also receives: The small saphenous vein. The veins corresponding to the branches of the artery.

14 Lymph nodes in the Popliteal Fossa: Are arranged as superficial and deep group they follow the femoral vessels to the deep inguinal lymph nodes. Superficial group: Are usually small and lie in the subcutaneous tissue. Deep group: Surrounds the vessles and receives from joint capsule of the knee and those that accompany the deep vein of the leg.

15 Tibial nerve It is a branch of the sciatic nerve. The tibial nerve passes through the popliteal fossa to pass below the arch of soleus. Root Value:(L4, L5,S1,S2,S3) In the popliteal fossa the nerve gives off branches to gastrocnemius, popliteus, soleus and plantaris muscles, an articular branch to the knee joint, and a cutaneous branch that will become the sural nerve. Three genicular branches: Superior Middle and Inferior. The Sural nerve is joined by fibres from the common fibular nerve and runs down the calf to supply the lateral side of the foot till the tip of little toe.

16 common fibular nerve (common peroneal nerve; external popliteal nerve; lateral popliteal nerve). Root Value: (L4, L5,S1,S2) About one-half the size of the tibial nerve. It is derived from the dorsal branches of the fourth and fifth lumbar and the first and second sacral nerves. It descends obliquely along the lateral side of the popliteal fossa to the head of the fibula, close to the medial margin of the biceps femoris muscle. Where the common peroneal nerve winds round the head of the fibular, it is palpable. Three genicular branches: Superior, inferior and recurrent nerves.

17 It lies between the tendon of the biceps femoris and lateral head of the gastrocnemius muscle, winds around the neck of the fibula, between the peroneus longus and the bone. It divides beneath the muscle into the superficial fibular nerve (superficial peroneal nerve) and deep fibular nerve (deep peroneal nerve). It innervates the Peroneus longus and Peroneus brevis muscles.

18 The boundaries of the fossa are: Medial Lateral Superior superior and medial: superior and lateral: the semitendinosus muscle and semimembranosus the biceps femoris muscle Inferior inferior and medial: the medial head of the gastrocnemius muscle inferior and lateral: the lateral head of the gastrocnemius muscle and plantaris

19 Clinical Significans of Popliteal Fossa Popliteal Pulse: Because the popliteal artery is deep in position so its difficult to feel the pulse, its best felt in the inferior part of the fossa,weakening or loss of the pulse is sign of a femoral artery obstruction. Popliteal Abscess and Tumor: Abscess or tumor are usually very painful and sever thoughness of fascia and limitation of expansion in the popliteal fossa.

20 Signs that the popliteal fossa may be experiencing.. Inflammation include pain, Tenderness, Reddening, and swelling. Itching the area can bring down the inflammation, as can taking antiinflammatory drugs. If pain persists or becomes worse, it is a good idea to consult a doctor for treatment recommendations. The knee joint is a common site for injuries, and a knee specialist can provide the highest level of care for popliteal fossa injuries

21 Clinical Relevance: 1. Swelling in the Popliteal Fossa The appearance of a mass in the popliteal fossa has many differential diagnoses. The two major causes are baker s cyst and aneurysm of the popliteal artery. Baker s Cyst A baker s cyst (or popliteal cyst) refers to the inflammation and swelling of the semimembranosus bursa a fluid filled sac found in the knee joint. The usually arise in conjunction with arthritis of the knee (rheumatoid or osteoarthritis). Whilst it usually self-resolves, the cyst can rupture and produce symptoms similar to deep vein thrombosis.

22 CliniCal RelevanCe..Con t Popliteal Aneurysm and Hemorrhage: Popliteal Aneurysm: Usually causes edema and pain the fossa it can be distinguished from other masses by palpable pulsation. Popliteal Hemorrhage: Fructure of the distal femur or dislocation of the knee may rupture the artery resulting in hemorrhage.

23 Peroneal nerve decompression: In the surgical treatment of fibular nerve compression, an incision is made over the neck of the fibula. Fascia surrounding the nerves to the lateral side of the leg is released. Deep peroneal nerve decompression: In the surgical treatment of deep fibular nerve entrapment in the foot, a ligament from the extensor digitorum brevis muscle that crosses over the deep peroneal nerve, putting pressure on it and causing pain, is released.

24 Chronic peroneal neuropathy can result from, among other conditions, bed rest of long duration, hyperflexion of the knee, peripheral neuropathy, pressure in obstetric stirrups. The most common cause is habitual leg crossing that compresses the common fibular nerve as it crosses around the head of fibula. Transient trauma to the nerve can result from peroneal strike. Damage to this nerve typically results in foot drop, where dorsiflexion of the foot is compromised and the foot drags (the toe points) during walking. Sensory loss to the dorsal surface of the foot and portions of the anterior, lower-lateral leg.

25 25 thank YoU.. 2/16/2018