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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
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