For medical, nursing, and physiotherapy undergraduates, and postgraduates

1. POPLITEAL FOSSA

2. INTRODUCTION
• It is a diamond shaped depression lying
behind Knee Joint, Lower part of femur and
Upper part of tibia.

3. BOUNDARIES
 Supero-laterally : Biceps femoris
 Supero-medially : Semitendinosus,
Semimembranosus, Gracilis, Sartorius and Adductor
magnus.
 Infero-laterally : Lateral head of gastrocnemius ,
plantaris.
 Infero -medially : Medial head of gastrocnemius.

5. BOUNDARIES
 Roof :
 Deep fascia / Popliteal fascia.
 Superficial fascia over the roof contains :
1. Small Saphenous vein and cutaneous nerves.
2. Branches & terminal part of Posterior
Cutaneous nerve of thigh
3. Posterior division of Medial Cutaneous nerve of
thigh
4. Peroneal / Sural Communicating nerve

8. BOUNDARIES
 Floor :
1. Popliteal surface of Femur
2. Capsule of knee joint & Oblique Popliteal
ligament
3. Strong Popliteal fascia covering Popliteus
muscle.

11. CONTENTS
1. Popliteal artery and its branches
2. Popliteal vein and its tributaries
3. Tibial nerve and its branches
4. Common Peroneal nerve and its branches
5. Posterior cutaneous nerve of thigh
6. Genicular branch of obturator nerve
7. Popliteal lymph nodes
8. Fat

14. ARRANGEMENT OF STRUCTURES
 Tibial nerve is most superficial
 Popliteal vein lies deep /anterior to tibial
nerve.
 Popliteal artery lies deep to all.

15. RELATION OF STRUCTURES
 In upper part :
 Medial to lateral – artery, vein & nerve
 In middle part :
 Behind forwards – nerve, vein & artery.
 In lower part :
 medial to lateral – nerve , vein & artery.

16. POPLITEAL ARTERY
 It is the continuation of Femoral artery.
 It begins at the opening in Adductor magnus
/Hiatus magnus.
 Runs down and laterally.
 Terminates at Lower Border of Popliteus into :
1. Anterior Tibial
2. Posterior Tibial

20. RELATIONS
 Anterior / Deep : Above down
1. Popliteal surface of femur
2. Back of knee joint
3. Fascia covering Popliteus
 Posterior / Superficial : Tibial nerve
 Laterally :
Upper part - Biceps femoris & lateral condyle of
femur
Lower part – Plantaris & lateral head of
gastrocnemius

21. RELATIONS
 Medially :
 Upper part – Semimembranosus & medial
condyle of femur
 Lower part : Tibial nerve, Popliteal Vein & Medial
Head of Gastrocnemius

23. BRANCHES
 Muscular :
• Upper 2-3 branches – Adductor magnus,
Hamstrings
• Lower branches – Gastrocnemius, Soleus and
Plantaris.
 Cutaneous branches :
• Arise directly from PA or indirectly from
muscular branches.
• One cutaneous branch always accompanies
Small saphenous vein.

24. BRANCHES
 Genicular :
1. Medial and Lateral Superior Genicular
2. Medial and Lateral Inferior Genicular
3. Middle Genicular

25. POPLITEAL VEIN
 It begins at the lower border of Popliteus by
union of veins accompanying the Anterior and
Posterior Tibial arteries.
 It continues as Femoral vein at the opening in
Adductor Magnus.
 It receives :
• Small saphenous vein
• Veins corresponding branches of Popliteal
artery

26. TIBIAL NERVE
 Root value : Ventral divisions of ventral rami
of L4,L5,S1,S2,S3.
 It is the larger terminal branch of sciatic
nerve.

27. COURSE
 It lies superficial or posterior to the popliteal
vessels.
 It extends from the superior angle to the
inferior angle of the Popliteal fossa crossing
the popliteal vessels from lateral to medial
side.
 it continues in the back of leg.

28. BRANCHES
 Genicular (three) :
1. Superior Medial Genicular
2. Middle Genicular
3. Inferior Medial Genicular
 Cutaneous :
• Sural nerve
 Muscular :
• For Lateral & medial heads of Gastrocnemius,
soleus, Plantaris and Popliteus.

29. COMMON PERONEAL NERVE
Root value : Dorsal divisions of Ventral rami of
L4,L5,S1,S2.
It is the smaller terminal branch of Sciatic
nerve.
It lies in the same plane as the Tibial nerve.

30. COURSE
 It extends from the superior angle of the
fossa to the lateral angle of the Popliteal fossa
along the medial border of the Biceps
Femoris.
 It continues downwards and forwards and
winds round the postero-lateral aspect of the
neck of fibula and divides into Superficial and
Deep Peroneal nerves.

31. BRANCHES
 Genicular (three) :
• Superior Lateral Genicular
• Inferior Lateral Genicular
• Recurrent Genicular
 Cutaneous :
• Lateral Cutaneous nerve of calf
• Sural Communicating nerve
 Muscular :
• None except a branch to short head of Biceps
Femoris occasionally.

33. POSTERIOR CUTANEOUS NERVE OF
THIGH
 Root value : S1,S2,S3.
 Descends down in back of thigh superficial to
Long head of Biceps femoris.
 On reaching fossa, it Pierces the fascial roof
around middle of Popliteal fossa and
accompanies small saphenous vein down to
middle of calf & communicates with Sural
nerve.

34. POSTERIOR CUTANEOUS NERVE OF
THIGH
 Branches :
1. Gluteal branches : 2-3 in number.
2. Perineal branches : supply posterior part of
Scrotum / Labia majora.
3. Perforating branches : supplies skin over back
of thigh, popliteal fossa & upper part of back
of leg.

35. GENICULAR BRANCH OF OBTURATOR
NERVE
 It is the continuation of Posterior division of
Obturator nerve.
 Pierces Oblique Popliteal ligament and
supplies Capsule of knee joint.

36. ANASTOMOSES AROUND KNEE JOINT
 It is a complicated arterial anastomoses around
Patella, Lower end of the Femur and Upper end of
Tibia.
 It is divisible into :
• Superficial part – partly lying in the Superficial
fascia around the Patella and partly in Fat behind
Ligamentum Patellae.
• Deep – lies all around articular surfaces of Femur
and Tibia

37. ANASTOMOSES AROUND KNEE JOINT
 It supplies :
1. Bones forming knee joint,
2. Synovial membrane and
3. Capsule of knee joint.

38. SCIATIC NERVE
 Thickest nerve of body, about 2 cm wide in
upper part.
 It begins in pelvis and terminates at the
Superior angle of Popliteal Fossa by dividing
into its terminal branches.
1. Tibial nerve
2. Common Peroneal nerve

39. ORIGIN AND ROOT VALUE
 Largest branch of sacral plexus.
L4, L5, S1, S2, S3.
 It has two components –
• Tibial – Ventral divisions of anterior primary
rami of L4,L5,S1,S2,S3 &
• Common Peroneal Nerve – Dorsal divisions of
anterior primary rami of L4,L5,S1,S2.

40. COURSE AND RELATIONS
 In the Pelvis : Lies in front of Piriformis
 In the Gluteal region :
• Enters gluteal region by passing below
Piriformis.
• It runs downwards with lateral convexity
between Ischial tuberosity and Greater
trochanter.

41. COURSE AND RELATIONS
 Relations :
• Superficial / Posterior –
• Deep / Anterior –
• Medial –

42. COURSE AND RELATIONS
 In the Thigh : It enters back of thigh at the
Lower Border of Gluteus Maximus.
 It runs vertically downwards up to Superior
angle of Popliteal fossa at the junction of
upper 2/3rd and lower 1/3rd of thigh.
 It terminates by dividing into :

43. COURSE AND RELATIONS
 Relations :
• Superficial / Posterior –
• Deep / Anterior –
• Medial –
• Lateral -

44. BRANCHES
 Articular : Hip joint in Gluteal region.
 Muscular :
• Tibial part – ST, SM, Long head of BF, Ischial
head of Adductor Magnus.
• Common Peroneal part – Short head of BF

45. TROCHANTERIC ANASTOMOSES
 This anastomoses is a channel of communication
between Internal Iliac and Femoral arteries.
 It is formed by :
1. Inferior division of Deep branch of Superior Gluteal
Artery
2. Ascending branch of Medial Circumflex Femoral
artery
3. Ascending branch of Lateral Circumflex Femoral
artery
4. Inferior Gluteal artery

46. TROCHANTERIC ANASTOMOSES
 It is situated in Trochanteric fossa and supplies
branches to Head of Femur.

48. CRUCIATE ANASTOMOSES
 This anastomoses is a channel of
communication between Internal Iliac and
Femoral arteries.
 Located at the level of Lesser trochanter.
 Cruciform in shape hence the name.

49. CRUCIATE ANASTOMOSES
 It is formed by :
• Above : Anastomotic branch of the Inferior
Gluteal artery
• Below : Ascending branch of First Perforating
artery.
• Medially : Transverse branch of Medial
Circumflex Femoral artery
• Laterally : Transverse branch of Lateral
Circumflex Femoral artery.

51. BACK OF THIGH

52. INTRODUCTION

53. MUSCLES / HAMSTRINGS
 Origin from Ischial Tuberosity
 Insertion into one of the bones of leg
 Nerve supply from the Tibial part of Sciatic
nerve
 They are Flexors of Knee and Extensors of hip.

54. MUSCLES / HAMSTRINGS
 Origin from Ischial Tuberosity
 Insertion into one of the bones of leg
 Nerve supply from the Tibial part of Sciatic
nerve
 They are Flexors of Knee and Extensors of hip.

55. SEMITENDINOSUS
Origin : Infero-medial impression on upper
part of Ischial Tuberosity
Insertion : Into upper part of medial surface of
tibia behind Sartorius and Gracilis.
Nerve supply :
Action :

56. SEMIMEMBRANOSUS
Origin : Supero-lateral impression on upper
part of Ischial Tuberosity
Insertion : Into groove on posterior surface of
medial condyle of Tibia.
• Expansions are -
Nerve supply :
Action :

57. BICEPS FEMORIS
Origin :
1. Infero-medial impression on upper part of
Ischial Tuberosity
2. Lower part of Sacro-tuberous ligament
Insertion :
• Into Head of Fibula in front of Styloid process
 Nerve supply :
Action :

58. ADDUCTOR MAGNUS
Origin :
• Lower lateral part of Ischial Tuberosity
• Ramus of ischium
• Lower part of Inferior Ramus of pubis
Insertion :
• Medial margin of Gluteal Tuberosity
• Linea aspera
• Medial supracondylar line
• Adductor tubercle

59. APPLIED ANATOMY
1. Blood pressure in Lower limb is recorded
from Popliteal artery.
2. Constant pulsations of PA against unyielding
tendon of Adductor Magnus leads to vascular
changes in the vessel wall – narrowing and
occlusion of artery.
3. Popliteal artery is fixed to the Capsule of
Knee joint by a fibrous band.
4. Popliteal artery is most prone for aneurysm
than any other artery in body.

60. APPLIED ANATOMY
5. Most of the muscular branches of Tibial
nerve arise from its lateral side except to
medial head of gastrocnemius. So medial
side is the safe side.
6. Common Peroneal nerve can be palpated
against Postero-lateral side of the neck of the
fibula.
7. It is the most frequently injured nerve in
lower limb.

61. APPLIED ANATOMY
• Testing of Hamstrings
• Sleeping foot
• Shooting pain along the distribution of sciatic
nerve is called Sciatica d/t compression of one
or more nerve roots.
• Semimembranosus Bursitis
• Baker’s cyst
• Injury to sciatic nerve – Foot drop