Flexor compartment of thigh

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

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

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

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

6. 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
MOB TCD

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

8. •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

9. •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

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

11. •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

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

13. •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

14. •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

15. •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

16. •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
Biceps Femoris
MOB TCD

17. 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
MOB TCD

18. •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

19. •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

20. •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

21. •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

22. •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

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

24. •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

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

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

27. •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

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

29. •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

30. 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
MOB TCD

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

33. 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
MOB TCD

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

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

36. 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
MOB TCD

37. 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
MOB TCD

38. “BMJ Publishing Group Limited (“BMJ Group”) 2012. All rights reserved.”