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Posterior compartment of thigh
- 1. Posterior compartment of thigh Dr Rajiv Ranjan RIMS, Ranchi D rR ajiv R anjan
- 2. POSTERIOR COMPARTMENT • True “Hamstrings” • Cross both the hip and the knee joint • Involved in knee flexion and hip extension • Semitendinosus, • Semimembranosus, • Biceps femoris(long head) • Adductor magnus ??? • Blood supply: perforating branches profunda femoris A (1st perforating A) • Innervation : tibial division of sciatic N (L5, S1&S2) D rR ajiv R anjan
- 4. Semitendinosus • Origin – ischial tuberosity • Insertion – as pes anserinus • Vascularity – medial circumflex femoral A & first perforating A • Innervation – Tibial div. of sciatic N • Distal Semitendinosus tendon is one of the tendons that can be used in the surgical procedure of ACL reconstruction D rR ajiv R anjan
- 5. Semimembranosus • Origin – ischial tuberosity • Insertion – Back of Medial tibial condyle • Vascular supply – perforating arteries usually 1st or 4th • Innervation – Sciatic nerve, L5, S1 and 2, through its Tibial division. D rR ajiv R anjan
- 6. Biceps femoris • Origin – long head – ischial tuberosity short head – lateral lip of linea aspera & lateral supracondylar line • Insertion – lateral side of the head of the fibula • Vascular supply – first and second perforating arteries • Innervation – sciatic nerve, L5, S1 and 2, • long head tibial division • short head common peroneal division D rR ajiv R anjan
- 7. Adductor Magnus Hamstring part O : Ischial tuberosity I : Adductor tubercle & medial supracondylar line Nerve supply : Tibial div. of sciatic N D rR ajiv R anjan
- 9. Actions of Hamstrings • Acting from above, the posterior femoral muscles flex the knee • Acting from below, they extend the hip joint • knee semi-flexed, biceps femoris is a lateral rotator and semimembranosus and semitendinosus are medial rotators of the leg on the thigh at the knee • Hip – extended, biceps is a lateral rotator and semimembranosus and semitendinosus are medial rotators of the thigh D rR ajiv R anjan
- 10. Testing & surface Localization D rR ajiv R anjan
- 11. Applied Seen among athletes Biceps femoris more prone D rR ajiv R anjan
- 14. Sciatic nerve The sciatic nerve is 2 cm wide at its origin (thickest) 2 components Tibial – L4, 5, S1, 2, 3 ventral div. of sacral plexus Common fibular/peroneal – L4, 5, S1, 2 dorsal div. of sacral plexus supplied by a branch from the inferior gluteal k/a artery of the sciatic nerve D rR ajiv R anjan
- 15. Sciatic nerve : course Leaves the pelvis via the greater sciatic foramen below piriformis descends between the greater trochanter and ischial tuberosity Superiorly it lies deep to gluteus maximus, resting first on the posterior ischial surface with the nerve to quadratus femoris between them. It then crosses posterior to obturator internus, the gemelli and quadratus femoris Q femoris separates it from obturator externus and the hip joint It is accompanied medially by the posterior femoral cutaneous nerve and the inferior gluteal artery. More distally it lies behind adductor magnus and is crossed posteriorly by the long head of biceps femoris D rR ajiv R anjan
- 16. Surface marking • Take 3 points, join them c̄ lateral convexity • 1st : 2.5 cm lateral to the line joining PSIS & IT • 2nd : midpoint of IT & G. trochanter • 3rd : apex of popliteal fossa at the junction of upper 2/3rd & lower 1/3rd of the back of thigh • Along the back of the thigh it divides into the tibial and common peroneal (fibular) nerves at a varying level proximal to the knee • Common site is at the junction of the middle and lower thirds of the thigh, near the apex of the popliteal fossaD rR ajiv R anjan
- 17. Branches • Articular branches arise from the upper part of the nerve and supply the hip-joint • Muscular branches to : biceps femoris, semitendinosus, semimembranosus, and adductor magnus • Terminal br : Tibial & Common Fibular ND rR ajiv R anjan
- 18. Applied • Most common cause of damage misplaced gluteal injections • Other causes include pelvic disease and severe trauma to the hip • Paralysis of the hamstrings and all the muscles of the leg and foot (foot drop) • sensory loss below the knee but not on the medial side of the leg or on the upper part of the calf D rR ajiv R anjan
- 19. Popliteal fossa Diamond-shaped space behind the knee Boundaries : Superomedially : semimembranosus & semitendinosus Superolaterally : biceps femoris Inferomedially : Medial head of gastrocnemius Inferolaterally : Lateral head of gastrocnemius Roof : Fascia lata (pierced by the small saphenous vein and the posterior femoral cutaneous N D rR ajiv R anjan
- 20. Popliteal fossa contents Varying amount of fat tibial and common peroneal nerves popliteal artery and vein popliteal group of lymph nodes lie alongside the popliteal vein. D rR ajiv R anjan
- 21. Popliteal fossa Floor is formed by : Popliteal surface of the femur The capsule of the knee joint reinforced by the oblique popliteal ligament & Popliteus muscle covered by its fascia D rR ajiv R anjan
- 22. Common Fibular N runs laterally downwards lying medial to the biceps tendon It disappears into the substance of peroneus longus To lie on the neck of the fibula (can be rolled) Branches Sural communicating N Lateral cutaneous N of the calf Superior and inferior genicular N of lateral side Recurrent genicular N D rR ajiv R anjan