This document provides information on the posterior compartment of the thigh. It describes the anatomy of the hamstring muscles - semimembranosus, semitendinosus, and biceps femoris - including their origins, insertions, innervation and actions. It also discusses the popliteal fossa and its contents, including the popliteal artery and veins, tibial and common peroneal nerves, and lymph nodes. Injuries to the hamstrings and neurovascular structures in the popliteal fossa are mentioned.

2. MOB TCD
Posterior Compartment of Thigh
Professor Emeritus Moira O’Brien
FRCPI, FFSEM, FFSEM (UK), FTCD
Trinity College
Dublin

3. MOB TCD
Posterior Compartment of Thigh
• Buttock to back of knee
• Separated from the extensor compartment
by lateral intermuscular septum
• Hamstrings

4. MOB TCD
Cutaneous Supply
• Posterior cutaneous nerve of thigh S2
• Posterior branch of lateral cutaneous of thigh

5. MOB TCD
Hamstrings
•
•
•
•
Fascia lata thin
Iliotibial tract, thick
Ischial tuberosity
Quadrilateral and
triangular
• Sciatic nerve
• Extends hip
• Flexes knee

6. MOB TCD
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

7. MOB TCD
Semimembranosus
• Becomes tendinous
• Inserted into the posterior surface of medial
condyle of tibia
• Three expansions

8. MOB TCD
Semimembranosus
• 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

9. MOB TCD
Semimembranosus
• The Semimembranosus bursa lies
between the tendon of semimembranosus 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

10. MOB TCD
Semimembranosus
• Extends hip
• Flexes and medially and rotates knee
• Tibial nerve

11. MOB TCD
Semitendinosus
• 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

12. MOB TCD
Semitendinosus
• Inserted upper part of subcutaneous
surface of tibia
• Behind sartorius and gracilis
• Tibial intertendinous bursa
• Tibial nerve

13. MOB TCD
Semitendinosus
• 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

14. MOB TCD
Biceps
• 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

15. MOB TCD
Biceps Femoris
• 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

16. MOB TCD
Biceps Femoris
• 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 muscle
Woods et al., 2004

17. 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 injury
Crosier, 2004

18. MOB TCD
Hamstrings
• 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

19. MOB TCD
Hamstrings
• 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

20. MOB TCD
Hamstrings
• 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

21. MOB TCD
Adductor Magnus
• Triangular area of ischial tuberosity
• Ramus of ischium
• Inserted into medial lip gluteal
tuberosity
• Linea aspera
• Medial supracondylar line
• Inserted into adductor tubercle

22. MOB TCD
Adductor Magnus
• 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

23. MOB TCD
Blood Supply
• Inferior gluteal vessels
• Perforating branches of the profunda
artery
• Popliteal artery

24. MOB TCD
Sciatic Nerve
• 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

25. MOB TCD
Popliteal Fossa
•
•
•
•
•
•
Diamond shaped space
Superomedial boundary
Semimembranosus
Semitendinosis
Superolateral boundary
Biceps femoris

26. MOB TCD
Popliteal Fossa
•
•
•
•
•
Inferomedial boundary
Medial head of gastronemius
Inferolateral boundary
Plantaris
Lateral head of gastronemius
lateral

27. MOB TCD
Popliteal Fossa
• 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

28. MOB TCD
Popliteal Fossa
•
•
•
•
•
Floor
Superior to inferior
Politeal surface of femur
Oblique popliteal ligament
Fascia covering the popliteus

29. MOB TCD
Contents of Popliteal Fossa
• 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

30. 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

31. 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
MOB TCD

32. MOB TCD
Dislocated Knee
• Injury to blood vessels most
serious
• Loose all blood supply to areas
below the knee
• Test for artery first, nerves after

33. MOB TCD
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

34. MOB TCD
Tibial Nerve
• Bisects middle of fossa superficial
to vein and artery
• Leaves deep to fibrous arch origin
of soleus
• Sural is cutaneous

35. MOB TCD
Tibial Nerve
• Muscular to medial and lateral
head of gastronemius
• Plantaris
• Soleus
• Popliteus
• Superior, inferior and middle
genicular nerves

36. 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

37. MOB TCD
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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