Flexor compartment of thigh

MOB TCD

Posterior Compartment of Thigh

Professor Emeritus Moira O’Brien

FRCPI, FFSEM, FFSEM (UK), FTCD

Trinity College

Dublin

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

• 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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• Becomes tendinous• Inserted into the posterior surface of medial

condyle of tibia• Three expansions

Semimembranosus MOB TCD

• 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

Semimembranosus MOB TCD

• The Semimembranosus bursa lies between the tendon of semi-membranosus 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

Semimembranosus MOB TCD

• Extends hip• Flexes and medially and rotates knee• Tibial nerve

Semimembranosus MOB TCD

• 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

Semitendinosus MOB TCD

• Inserted upper part of subcutaneous surface of tibia

• Behind sartorius and gracilis• Tibial intertendinous bursa• Tibial nerve

Semitendinosus MOB TCD

• 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

Semitendinosus MOB TCD

• 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

Biceps MOB TCD

• 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

Biceps Femoris MOB TCD

• 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 muscleWoods et al., 2004

Biceps Femoris MOB TCD

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 injuryCrosier, 2004

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• 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

Hamstrings MOB TCD

• 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

Hamstrings MOB TCD

• 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

Hamstrings MOB TCD

• Triangular area of ischial tuberosity• Ramus of ischium• Inserted into medial lip gluteal

tuberosity• Linea aspera • Medial supracondylar line• Inserted into adductor tubercle

Adductor Magnus MOB TCD

• 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

Adductor Magnus MOB TCD

• Inferior gluteal vessels• Perforating branches of the profunda

artery• Popliteal artery

Blood Supply MOB TCD

• 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

Sciatic Nerve MOB TCD

Popliteal Fossa

• Diamond shaped space• Superomedial boundary• Semimembranosus • Semitendinosis• Superolateral boundary• Biceps femoris

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• Inferomedial boundary • Medial head of gastronemius• Inferolateral boundary• Plantaris• Lateral head of gastronemius

lateral

Popliteal Fossa MOB TCD

• 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

Popliteal Fossa MOB TCD

• Floor• Superior to inferior• Politeal surface of femur• Oblique popliteal ligament• Fascia covering the popliteus

Popliteal Fossa MOB TCD

• 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

Contents of Popliteal Fossa MOB TCD

Popliteal Artery

• 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

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Genicular Branches of Popliteal Artery

• 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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• Muscular to medial and lateral head of gastronemius

• Plantaris• Soleus • Popliteus• Superior, inferior and middle

genicular nerves

Tibial Nerve MOB TCD

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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