Transcript Flexor Compartment of Thigh

MOB TCD
Posterior Compartment of Thigh
Professor Emeritus Moira O’Brien
FRCPI, FFSEM, FFSEM (UK), FTCD
Trinity College
Dublin
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Posterior Compartment of Thigh
• Buttock to back of knee
• Separated from the extensor compartment
by lateral intermuscular septum
• Hamstrings
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Cutaneous Supply
• Posterior cutaneous nerve of thigh S2
• Posterior branch of lateral cutaneous of thigh
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Hamstrings
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Fascia lata thin
Iliotibial tract, thick
Ischial tuberosity
Quadrilateral and
triangular
• Sciatic nerve
• Extends hip
• Flexes knee
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Semimembranosus
• Smooth upper lateral
portion of ischial
tuberosity
• Origin long flat
membrane for 15 cm
• Rounded laterally
• Sharp medial border
• Deep to semitendinosus
and biceps
• Muscle appears half
membranous
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Semimembranosus
• Becomes tendinous
• Inserted into the posterior surface of medial
condyle of tibia
• Three expansions
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Semimembranosus
• Expansion downwards and medially
along the medial surface of tibia
• Upwards and laterally; oblique
popliteal ligament
• Which is pierced by middle
genicular vessels and nerve, post
division obturator nerve
• Downwards and laterally as fascia
covering popliteus
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Semimembranosus
• The Semimembranosus bursa lies
between the tendon of semimembranosus and
• The medial condyle of the tibia and the
medial head of gastrocnemius
• May communicate with the bursa between
the medial head of gastrocnemius and the
fibrous capsule of the knee joint
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Semimembranosus
• Extends hip
• Flexes and medially and rotates knee
• Tibial nerve
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Semitendinosus
• Common origin with the long head of the
biceps
• Lower medial area of ischial tuberosity
• Fleshy fibres of origin replaced by a
tendon
• Lies in the gutter of semimembranosus
• Curves forward
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Semitendinosus
• Inserted upper part of subcutaneous
surface of tibia
• Behind sartorius and gracilis
• Tibial intertendinous bursa
• Tibial nerve
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Semitendinosus
• Develops from myotomes
• There is a tendinous
intersection at the junction of
the upper and middle thirds of
the muscle, which is a common
site of tears
Lee and O’Brien, 1988
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Biceps
• Long head has common origin
with the semitendinosus
• Lower medial area of ischial
tuberosity
• Short head from linea aspera
• Upper part of lateral
supracondylar line
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Biceps Femoris
• Inserted into head of
fibula in front of styloid
process
• Folded around lateral
ligament of knee
• Long head extends hip
• Tibial nerve supplies
long head
• Short head by common
peroneal nerve
• Both heads flex and
laterally rotates knee
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Biceps Femoris
• 80% of hamstring strains occur in the occur in the long
head of the biceps femoris muscle
Koulouris & Connell, 2003
• Injuries may occur:
• During the switch between late leg recovery and initial
leg approach in the swing phase of sprinting
Woods et al., 2004
• During the ground contact phase of running
• Poor timing-intermuscular coordination and eccentric
strength in the short head of the biceps femoris muscle
Woods et al., 2004
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Biceps Femoris
• Lack of stiffness and eccentric strength in the short and
long head of the biceps femoris muscle during the
ground contact phase of running
Bosch and Klomp, 2005
• Can be torn at origin from tuberosity
• Middle of thigh
• Prior hamstring injury is a very good indicator of
potential for future injury
Crosier, 2004
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Hamstrings
• Hamstrings act eccentrically in the
swing phase of gait to resist hip
flexion and knee extension
• Extends the hip with the gluteus
Maximus for propulsion forwards at
the start of heel strike
• The hamstrings contract with the
quadriceps as the hip of the
supporting leg moves over the foot
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Hamstrings
• Avulsion of the epiphysis
of the ischial tuberosity
origin of the hamstrings
• In young athletes, the
whole of the ischial
tuberosity and the attached
origins of the hamstrings
may be avulsed
Ishikawa et al., 1988; Kurosawa et al., 1996
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Hamstrings
• Poor posture, stiff lumbar spine and
weak abdominals, will predispose to
tight hamstrings
• Tight hamstrings will shorten the stride
• Resulting in a faster work rate over a
given distance but a slower time
• Hamstrings used in sprinting and
hurdles
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Adductor Magnus
• Triangular area of ischial tuberosity
• Ramus of ischium
• Inserted into medial lip gluteal
tuberosity
• Linea aspera
• Medial supracondylar line
• Inserted into adductor tubercle
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Adductor Magnus
• Adductor portion supplied by
posterior division of obturator
nerve
• Hamstring portion, below hiatus
for femoral vessels
• Supplied by tibial nerve
• Gives origin to the oblique fibres
of the vastus medialis
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Blood Supply
• Inferior gluteal vessels
• Perforating branches of the profunda
artery
• Popliteal artery
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Sciatic Nerve
• Leaves through the greater sciatic
foramen
• Runs vertically down deep to the
biceps on adductor magnus
• Divides into tibial and common
peroneal middle of thigh
• If it divides in the pelvis common
peroneal pierces piriformis
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Popliteal Fossa
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Diamond shaped space
Superomedial boundary
Semimembranosus
Semitendinosis
Superolateral boundary
Biceps femoris
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Popliteal Fossa
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Inferomedial boundary
Medial head of gastronemius
Inferolateral boundary
Plantaris
Lateral head of gastronemius
lateral
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Popliteal Fossa
• Roof
• Fascia Lata reinforced by transverse fibres
• Pierced by the posterior cutaneous nerve
of the thigh
• Short Saphenous vein
• Superficial lymphatics from lateral and
posterior part of leg
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Popliteal Fossa
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Floor
Superior to inferior
Politeal surface of femur
Oblique popliteal ligament
Fascia covering the popliteus
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Contents of Popliteal Fossa
• Popliteal artery and its branches
• Superomedial, superolateral, inferomedial,
inferolateral and middle genicular branches
• Popliteal vein and tributaries
• Short saphenous vein
• Tibial nerve and branches
• Common peroneal nerve and branches
• Posterior division of Obturator nerve
• Fat
• Deep popliteal lymph glands
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Popliteal Artery
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Deepest structure which lies on floor
Starts at the hiatus in the adductor magnus
Ends at lower border of popliteus
Divides into anterior and posterior tibial
artery
• Medial then lateral to tibial nerve, vein in
between
• Palpate artery and blood pressure in lower
limb
Genicular Branches of
Popliteal Artery
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Superolateral genicular
Superolateral genicular
Inferolateral genicular
Inferomedial genicular
Middle genicular pierces oblique popliteal
ligament
• Supplies cruciate ligaments
• Branches crucify artery at the back of knee
joint
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Dislocated Knee
• Injury to blood vessels most
serious
• Loose all blood supply to areas
below the knee
• Test for artery first, nerves after
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Popliteal Vein
• Union of vena commitans of anterior and
posterior tibial arteries
• Lower border of popliteus
• Ends by becoming femoral vein at hiatus
• Tributaries correspond to branches
• Plus short saphaneous vein
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Tibial Nerve
• Bisects middle of fossa superficial
to vein and artery
• Leaves deep to fibrous arch origin
of soleus
• Sural is cutaneous
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Tibial Nerve
• Muscular to medial and lateral
head of gastronemius
• Plantaris
• Soleus
• Popliteus
• Superior, inferior and middle
genicular nerves
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Common Peroneal Nerve
• May pierce piriformis
• Enters fossa and runs on medial border
of biceps
• Leaves lateral angle
• Sural communicating
• Lateral cutaneous of calf
• Inferolateral
• Inferomedial genicular
• Nerve to short head of biceps
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Deep Popliteal Lymph Glands
• Superficial lymphatics drain lateral border of
foot and posterior portion of calf
• Area drained by the short saphenous vein
• Afferent lymphatics pierce the roof to deep
popliteal glands in the fossa
• Then pass alongside the popliteal and
femoral vessels to deep inguinal glands
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