Contents of the Posterior Fascial Compartment of the Thigh

Transcription

1 Contents of the Posterior Fascial Compartment of the Thigh 1-Muscles: B i c e p s f e m o r i s S e m i t e n d i n o s u s S e m i m e m b r a n o s u s a small part of the adductor magnus (h a m s t r i n g part o r i s c h i a l p a r t ) 2-Blood supply: Branches of the profunda femoris artery 3-Nerve supply: S c i a t i c n e r v e B i c e p s f e m o r i s Origin: Long head: ischial tuberosity Short head: linea aspera, lateral supracondylar ridge of shaft of femur Insertion: Head of fibula Nerve supply: Long head: tibial portion of sciatic nerve Short head: common peroneal portion of sciatic nerve Actions: Flexes and laterally rotates leg at knee joint; long head also extends thigh at hip joint

2 Origin: Ischial tuberosity Where? S e m i t e n d i n o s u s Insertion: Upper part of medial surface of shaft of tibia (SGS area) Nerve supply: Tibial portion of sciatic nerve Actions: Flexes and medially rotates leg at knee joint; extends thigh at hip joint S e m i m e m b r a n o s u s Origin: Ischial tuberosity, where? Insertion: Medial condyle of tibia Nerve supply: Tibial portion of sciatic nerve Actions: Flexes and medially rotates leg at knee joint; extends thigh at hip joint A d d u c t o r m a g n u s ( h a m s t r i n g p o r t i o n ) Or ischial part Origin: Ischial tuberosity Insertion: Adductor tubercle of femur Nerve supply: Tibial portion of sciatic nerve Actions: E x t e n d s t h i g h a t h i p j o i n t D o e s i t f l e x t h e k n e e?

3 Pay attention to the fact that the muscles of the thigh are designed To act on the knee joint For example, quadriceps femoris occupies the anterior compartment of the thigh but its Main action is to extend the knee joint The same should be considered for the muscles of the posterior compartment of the thigh Although they occupy the posterior compartment of the thigh Their main function is to flex the knee joint Now think! Which muscles will rotate the knee joint medially and laterally? Keep in your mind that when the knee joint is extended medial and lateral rotation is not possible! The joint said to be locked Therefore, we need to unlock the extended (locked) knee joint A small muscle called popliteus unlocks the knee joint by rotating the femur on the tibia laterally before any flexion of the knee can take place Now the joint said to be unlocked Only now when the knee joint is semiflexed The biceps femoris can act as lateral rotators of the leg The semimembranousus and semitendinosus can act as medial rotators of the leg

4 S c i a t i c N e r v e A terminal branch of the sacral plexus (L4 and 5; S1, 2, and 3) Emerges from the pelvis through the lower part of the greater sciatic foramen below the piriformis muscle It is the largest nerve in the body and consists of the tibial and common peroneal nerves bound together with fascia. Commonly terminates in the middle of the thigh by dividing into T i b i a l N e r v e (medial popliteal nerve) and C o m m o n p e r o n e a l (lateral popliteal nerve ALSO CALLED common fibular nerve

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6 A better surface marking for the safe area of buttock injections can be defined as that area which lies under the outstretched hand when the thumb and thenar eminence are placed along the iliac crest with the tip of the thumb touching the anterior superior iliac spine

7 P o s t e r i o r C u t a n e o u s N e r v e o f t h e T h i g h A branch of the sacral plexus S1,2,3. Enters the gluteal region through the lower part of the greater sciatic foramen below the piriformis muscle It passes downward on the posterior surface of the sciatic nerve and runs down the back of the thigh beneath the deep fascia. In the popliteal fossa it supplies the skin OVER THE BACK OF THE thigh and upper part of the leg.

8 The popliteal fossa

9 P o p l i t e a l F o s s a Is a diamond-shaped intermuscular space situated at the back of the knee Boundaries Laterally: (above) The biceps femoris (below) The lateral head of the gastrocnemius and Plantaris Medially: (above) The semimembranosus and semitendinosus (below) The medial head of the gastrocnemius The Floor is formed by The popliteal surface of the femur, The posterior surface of the knee joint, The popliteus muscle. The Roof is formed by Skin Superficial fascia The deep fascia of the thigh.

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11 C o n t e n t s o f t h e p o p l i t e a l f o s s a Popliteal artery and vein The common peroneal nerve(lateral popliteal nerve) Tibial nerve(medial popliteal nerve) The posterior cutaneous nerve of the thigh The small saphenous vein Connective tissue, and lymph nodes. T h e p o p l i t e a l a r t e r y Enters the popliteal fossa through the opening in the adductor magnus as a continuation of the femoral artery (the deepest structure in the fossa). It ends at the level of the lower border of the popliteus muscle by dividing into anterior and posterior tibial arteries Branches Muscular branches Articular ( genicular) branches to the knee. important AT the middle of the fossa The popliteal artery is the deepest structure While the vein is intermediate and the tibial nerve Is most superficial

12 T i b i a l N e r v e 2-Muscular: branches supply both heads of the gastrocnemius and the plantaris, soleus, and popliteus 3-Articular: branches supply the knee joint. The larger terminal branch of the sciatic nerve Arises in the lower third of the thigh. It runs downward through the popliteal fossa Enters the posterior compartment of the leg by passing beneath the soleus muscle. Branches 1-Cutaneous: The sural nerve descends between the two heads of the gastrocnemius muscle Supplies the skin of the calf and the back of the leg. The sural nerve accompanies the small saphenous vein behind the lateral malleolus and is distributed to the skin along the lateral border of the foot and the lateral side of the little toe

13 C o m m o n P e r o n e a l N e r v e The smaller terminal branch of the sciatic nerve Arises in the lower third of the thigh. It runs downward through the popliteal fossa It leaves the fossa by crossing superficially the lateral head of the gastrocnemius muscle. It then passes behind the head of the fibula, winds laterally around the neck of the bone (subcutaneous and exposed to injury), pierces the peroneus longus muscle. Divides into two terminal branches: The superficial peroneal nerve The deep peroneal nerve

14 Branches Cutaneous: The sural communicating branch The lateral cutaneous nerve of the calf supplies the skin on the lateral side of the back of the leg Muscular branch: to the short head of the biceps femoris muscle, which arises high up in the popliteal fossa Articular: branches to the knee joint The superficial peroneal nerve Also called the musclocutaneous nerve of the leg, Supplies two muscles and then becomes cutaneous where It supplies the skin over the leg

15 Read only The popliteal fossa is a good example of the value of thinking anatomically when considering the differential diagnosis of a mass situated in a particular anatomical area. When examining a lump in the popliteal region, think of these possibilities: skin and soft tissues sebaceous cyst, lipoma, sarcoma vein varicosities of the short saphenous vein in the roof of the fossa artery popliteal aneurysm lymph nodes infection secondary to suppuration in the foot knee joint joint effusion tendons enlarged bursae, especially those beneath semimembranosus and the heads of gastrocnemius bones a tumour of the lower end of femur or upper end of tibia

16 Patella Triangular sesamoid bone Contained within patellar ligament

17 Lateral condyle Tuberosity Of Tibia Upper end Medial condyle Anterior view Right Tibia Medial surface Posterior view Groove for Semimembranosus Area for popliteus muscle Fibular facet Soleal line Lateral surface Interosseous border Directed laterally Lower end Anterior border shin tibia Medial border Fibular notch Medial malleolus Inferior articular surface Groove for tibialis posterior* Vertical line Posterior surface The shaft of the tibia is subcutaneous and unprotected anteromedially throughout its course. It is not surprising that the tibia is the commonest long bone to be fractured.the extensive subcutaneous surface of the tibia makes it an accessible donor site for bonegrafts Fibular notch

18 Styloid process Head Articular facet of the head Neck 1-Lateral surface Provides origin to The muscles in the lateral compartment of the leg Anterior border Subcutaneous triangular area Lateral malleolus * Right fibula- anterior view 2-Anterior surface provides origin to the extensor muscles of the leg Extensor surface 3-Posterior surface provides origin to some of the flexor muscles of the leg flexor surface Medial creast Interosseous border * Malleolar fossa, located on the medial surface of the lateral malleolus Inferior Posterior medial in position helps to determine left or right

19 The common peroneal nerve is related to the neck of fibula The common peroneal nerve in this area is covered by skin and fascia only therefore it is exposed to injuries Foot drop

20 First metatarsal bone Medial cuneiform bone Distal phalanx Middle phalanx Proximal phalanx Fifth metatarsal bone Intermediate cuneiform bone Lateral cuneiform bone Navicular bone Cuboid bone Talus bone Bones of the right foot C a l c a n e u s

21 A) B) C) The sulcus tali and the sulcus calcanei in the articulated foot form a tunnel, the sinus tarsi, which is occupied by the strong interosseous talocalcaneal ligament.

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23 nsertion of peroneus brevis muscle

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