Back of Thigh & Back of Thigh & Popliteal FossaPopliteal Fossa

Dr. Mujahid KhanDr. Mujahid Khan

Skin & Cutaneous NervesSkin & Cutaneous Nerves

The posterior cutaneous nerve of thigh is a branch of the The posterior cutaneous nerve of thigh is a branch of the sacral plexussacral plexus

Leaves the gluteal region by emerging from beneath the Leaves the gluteal region by emerging from beneath the lower border of the gluteus maximuslower border of the gluteus maximus

Descends on the back of thigh Descends on the back of thigh

In the popliteal fossa it pierces the deep fascia and In the popliteal fossa it pierces the deep fascia and supplies the skinsupplies the skin

Gives off branches to the skin on the back of the thigh Gives off branches to the skin on the back of the thigh and upper part of legand upper part of leg

Superficial VeinsSuperficial Veins

Many small veins curve around the medial and Many small veins curve around the medial and lateral aspects of the thigh lateral aspects of the thigh

They drain into the great saphenous veinThey drain into the great saphenous vein

Superficial veins form in the lower part of the Superficial veins form in the lower part of the back of thigh join small saphenous vein in the back of thigh join small saphenous vein in the popliteal fossapopliteal fossa

Lymph from the skin and superficial fascia drain Lymph from the skin and superficial fascia drain into the vertical group of superficial inguinal into the vertical group of superficial inguinal lymph nodeslymph nodes

ContentsContents

Muscles: Biceps femoris, semitendinosus, Muscles: Biceps femoris, semitendinosus, semimembranosus, and a small part of the semimembranosus, and a small part of the adductor magnus adductor magnus

Blood Supply: Branches of the profunda Blood Supply: Branches of the profunda femoris arteryfemoris artery

Nerve Supply: Sciatic NerveNerve Supply: Sciatic Nerve

Biceps FemorisBiceps Femoris

Origin: The long head from the ischial tuberosityOrigin: The long head from the ischial tuberosity

Short head from the linea aspera and the lateral Short head from the linea aspera and the lateral supracondylar ridge of the shaft of the femursupracondylar ridge of the shaft of the femur

Insertion: Two heads unite just above the knee joint and Insertion: Two heads unite just above the knee joint and insert into the head of the fibulainsert into the head of the fibula

Nerve Supply: Long head by the tibial part of the sciatic, Nerve Supply: Long head by the tibial part of the sciatic, short head by the common peroneal part of sciaticshort head by the common peroneal part of sciatic

Action: Flexes and laterally rotates the leg at the knee Action: Flexes and laterally rotates the leg at the knee joint, long head extends the thigh at the hip jointjoint, long head extends the thigh at the hip joint

SemitendinosusSemitendinosus

Origin: From the ischial tuberosityOrigin: From the ischial tuberosity

Insertion: By a long tendon into the upper part of Insertion: By a long tendon into the upper part of the medial surface of the shaft of the tibiathe medial surface of the shaft of the tibia

Nerve Supply: The tibial portion of sciatic nerveNerve Supply: The tibial portion of sciatic nerve

Action: Flexes and medially rotates the leg at the Action: Flexes and medially rotates the leg at the knee, extends the thigh at the hip jointknee, extends the thigh at the hip joint

SemimembranosusSemimembranosus

Origin: From the ischial tuberosity Origin: From the ischial tuberosity

Insertion: Into the posteromedial surface of the Insertion: Into the posteromedial surface of the medial condyle of the tibiamedial condyle of the tibia

It sends a fibrous expansion on the back of the It sends a fibrous expansion on the back of the knee joint called oblique popliteal ligamentknee joint called oblique popliteal ligament

Nerve Supply: Tibial part of the sciatic nerve Nerve Supply: Tibial part of the sciatic nerve

Action: Flexes and medially rotates the leg at the Action: Flexes and medially rotates the leg at the knee joint, extends thigh at the hip jointknee joint, extends thigh at the hip joint

Adductor Magnus Adductor Magnus (Hamstring Portion)(Hamstring Portion)

Origin: Ischial tuberosityOrigin: Ischial tuberosity

Insertion: Adductor tubercle of femurInsertion: Adductor tubercle of femur

Nerve Supply: Tibial portion of sciatic Nerve Supply: Tibial portion of sciatic nervenerve

Action: Extends thigh at hip jointAction: Extends thigh at hip joint

Blood SupplyBlood Supply

The four perforating branches of the The four perforating branches of the profunda femoris artery provide a rich profunda femoris artery provide a rich blood supply to this compartment blood supply to this compartment

The profunda femoris vein drains the The profunda femoris vein drains the greater part of the blood from the greater part of the blood from the compartmentcompartment

Sciatic NerveSciatic Nerve

It is a branch of sacral plexusIt is a branch of sacral plexus

It leaves the gluteal region as it descends in the It leaves the gluteal region as it descends in the midline of the thighmidline of the thigh

It is overlapped posteriorly by the adjacent It is overlapped posteriorly by the adjacent margins of the biceps femoris and margins of the biceps femoris and semimembranosus musclessemimembranosus muscles

It lies on the posterior aspect of the adductor It lies on the posterior aspect of the adductor magnus musclemagnus muscle

Sciatic NerveSciatic Nerve

In the lower third of the thigh it ends by In the lower third of the thigh it ends by dividing into the tibial and common dividing into the tibial and common peroneal nervesperoneal nerves

Occasionally, the sciatic nerve divides into Occasionally, the sciatic nerve divides into its two terminal parts at a higher level, in its two terminal parts at a higher level, in the upper part of the thigh, the gluteal the upper part of the thigh, the gluteal region, or even inside the pelvisregion, or even inside the pelvis

Branches of Sciatic NerveBranches of Sciatic Nerve

Tibial Nerve: It enters the popliteal fossaTibial Nerve: It enters the popliteal fossa

Common Peroneal Nerve: It enters the popliteal Common Peroneal Nerve: It enters the popliteal fossa on the lateral side of the tibial nervefossa on the lateral side of the tibial nerve

Muscular Branches: To the long head of the Muscular Branches: To the long head of the biceps femoris, the semitendinosus, the biceps femoris, the semitendinosus, the semimembranosus, and the hamstring part of semimembranosus, and the hamstring part of the adductor magnus, These branches arise the adductor magnus, These branches arise from the tibial component and run medially from the tibial component and run medially

Popliteal FossaPopliteal Fossa

Popliteal fossa is a diamond-shaped Popliteal fossa is a diamond-shaped intermuscular space situated at the back of the intermuscular space situated at the back of the kneeknee

It is more prominent when the knee is flexedIt is more prominent when the knee is flexed

It contains the popliteal vessels, the small It contains the popliteal vessels, the small saphenous vein, the common peroneal and tibial saphenous vein, the common peroneal and tibial nerves, the posterior cutaneous nerve of the nerves, the posterior cutaneous nerve of the thigh, the genicular branch of the obturator thigh, the genicular branch of the obturator nerve, connective tissue and lymph nodesnerve, connective tissue and lymph nodes

Boundaries of Popliteal FossaBoundaries of Popliteal Fossa

Laterally: Biceps femoris above and the Laterally: Biceps femoris above and the lateral head of gastrocnemius and lateral head of gastrocnemius and plantaris belowplantaris below

Medially: the semimembranosus and the Medially: the semimembranosus and the semitendinosus above and the medial semitendinosus above and the medial head of the gastrocnemius belowhead of the gastrocnemius below

Boundaries of Popliteal FossaBoundaries of Popliteal Fossa

The anterior wall or floor of the fossa is The anterior wall or floor of the fossa is formed by the popliteal surface of the formed by the popliteal surface of the femur, the posterior ligament of the knee femur, the posterior ligament of the knee joint, and the popliteus musclejoint, and the popliteus muscle

The roof is formed by skin, superficial The roof is formed by skin, superficial fascia, and the deep fascia of the thighfascia, and the deep fascia of the thigh

Popliteus MusclePopliteus Muscle

Origin: From the lateral surface of the lateral Origin: From the lateral surface of the lateral condyle of the femur by a rounded tendon and condyle of the femur by a rounded tendon and by a few fibers from the lateral semilunar by a few fibers from the lateral semilunar cartilagecartilage

Insertion: Posterior surface of tibia, above the Insertion: Posterior surface of tibia, above the soleal linesoleal line

It arises within the capsule of the knee joint and It arises within the capsule of the knee joint and emerges through the lower part of the capsule of emerges through the lower part of the capsule of the joint the joint

Popliteus MusclePopliteus Muscle

Nerve Supply: Tibial nerveNerve Supply: Tibial nerve

Action: Medial rotation of the tibia on the Action: Medial rotation of the tibia on the femurfemur

If the foot is on the ground, lateral rotation If the foot is on the ground, lateral rotation of the femur on the tibiaof the femur on the tibia

This action is also called unlocking of the This action is also called unlocking of the knee jointknee joint

Popliteal ArteryPopliteal Artery

The popliteal artery is deeply placed The popliteal artery is deeply placed

It is a continuation of the femoral arteryIt is a continuation of the femoral artery

It enters the popliteal fossa through the It enters the popliteal fossa through the opening in the adductor magnusopening in the adductor magnus

It ends at the level of the lower border of It ends at the level of the lower border of the popliteus muscle by dividing into the popliteus muscle by dividing into anterior and posterior tibial arteriesanterior and posterior tibial arteries

Relations of Popliteal ArteryRelations of Popliteal Artery

Anteriorly: The popliteal surface of the Anteriorly: The popliteal surface of the femur, the knee joint, and the popliteus femur, the knee joint, and the popliteus musclemuscle

Posteriorly: The popliteal vein and the Posteriorly: The popliteal vein and the tibial nerve, fascia and skintibial nerve, fascia and skin

Branches: Muscular branches and Branches: Muscular branches and articular branchesarticular branches

Popliteal VeinPopliteal Vein

The popliteal vein is formed by the junction of The popliteal vein is formed by the junction of the venae comitantes of the anterior and the venae comitantes of the anterior and posterior tibial arteries posterior tibial arteries

Forms at the lower border of the popliteus Forms at the lower border of the popliteus musclemuscle

On the medial side of the popliteal arteryOn the medial side of the popliteal artery

It passes through the opening in the adductor It passes through the opening in the adductor magnus to become the femoral veinmagnus to become the femoral vein

Tributaries of Popliteal VeinTributaries of Popliteal Vein

Veins that correspond to branches given Veins that correspond to branches given off by the popliteal arteryoff by the popliteal artery

Small saphenous vein, perforates the Small saphenous vein, perforates the deep fascia and passes between the two deep fascia and passes between the two heads of the gastrocnemius muscle to end heads of the gastrocnemius muscle to end in the popliteal vein in the popliteal vein

Arterial Anastomosis Around Arterial Anastomosis Around Knee JointKnee Joint

To compensate for the narrowing of the popliteal To compensate for the narrowing of the popliteal artery which occurs during extreme flexion of the artery which occurs during extreme flexion of the kneeknee

Around the knee joint a profuse anastomosis of Around the knee joint a profuse anastomosis of small branches of the femoral artery is presentsmall branches of the femoral artery is present

It is joined by the muscular and articular It is joined by the muscular and articular branches of the popliteal artery and with branches of the popliteal artery and with branches of the anterior and posterior tibial branches of the anterior and posterior tibial arteriesarteries

Popliteal Lymph NodesPopliteal Lymph Nodes

About six lymph nodes are embedded in the About six lymph nodes are embedded in the fatty connective tissue of the popliteal fossafatty connective tissue of the popliteal fossa

They receive superficial lymph vessels from the They receive superficial lymph vessels from the lateral side of the foot and popliteal fossalateral side of the foot and popliteal fossa

They also receive lymph from the knee joint and They also receive lymph from the knee joint and from deep lymph vessels accompanying the from deep lymph vessels accompanying the anterior and posterior tibial arteriesanterior and posterior tibial arteries

Tibial NerveTibial Nerve

It is the larger terminal branch of the sciatic It is the larger terminal branch of the sciatic nervenerve

It arises in the lower third of the thighIt arises in the lower third of the thigh

It runs downward through the popliteal fossaIt runs downward through the popliteal fossa

Lying first on the lateral side of the popliteal Lying first on the lateral side of the popliteal artery then posterior to itartery then posterior to it

It enters the posterior compartment of the leg by It enters the posterior compartment of the leg by passing beneath the soleus musclepassing beneath the soleus muscle

Branches of Tibial NerveBranches of Tibial Nerve

Cutaneous: Usually joined by the sural Cutaneous: Usually joined by the sural communicating branchcommunicating branch

Muscular: Supply both heads of the Muscular: Supply both heads of the gastrocnemius and plantaris, soleus and gastrocnemius and plantaris, soleus and popliteuspopliteus

Articular: Supply the knee jointArticular: Supply the knee joint

Common Peroneal NerveCommon Peroneal Nerve

It is a smaller terminal branch of the sciatic It is a smaller terminal branch of the sciatic nervenerve

Arises in the lower third of the thighArises in the lower third of the thigh

Runs downward through the popliteal fossaRuns downward through the popliteal fossa

Leaves the fossa by crossing superficially to the Leaves the fossa by crossing superficially to the lateral head of the gastrocnemius musclelateral head of the gastrocnemius muscle

Common Peroneal NerveCommon Peroneal Nerve

Passes behind the head of the fibulaPasses behind the head of the fibula

Winds around the neck of fibulaWinds around the neck of fibula

Pierces the peroneus longus muscle Pierces the peroneus longus muscle

Divides into two terminal branches: the Divides into two terminal branches: the superficial peroneal and deep peroneal nervessuperficial peroneal and deep peroneal nerves

It is subcutaneous and can be rolled against the It is subcutaneous and can be rolled against the neck of the fibulaneck of the fibula

Branches of Common Branches of Common Peroneal NervePeroneal Nerve

Cutaneous: sural communicating branch, Cutaneous: sural communicating branch, the lateral cutaneous nerve of the calf the lateral cutaneous nerve of the calf supplies the lateral side of the back of the supplies the lateral side of the back of the legleg

Muscular: supply to the short head of Muscular: supply to the short head of biceps femoris biceps femoris

Articular branches to the knee jointArticular branches to the knee joint