flexor compartment of thigh bmj
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MOB TCD
Posterior Compartment of Thigh
Professor Emeritus Moira OBrien
FRCPI, FFSEM, FFSEM (UK), FTCD
Trinity College
Dublin
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Posterior Compartment of Thigh
Buttock to back of knee Separated from the extensor compartment
by lateral intermuscular septum
Hamstrings
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Cutaneous Supply
Posterior cutaneous nerve of thigh S2 Posterior branch of lateral cutaneous of thigh
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Hamstrings
Fascia lata thin Iliotibial tract, thick
Ischial tuberosity
Quadrilateral and
triangular
Sciatic nerve
Extends hip
Flexes knee
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Semimembranosus
Smooth upper lateralportion of ischial
tuberosity
Origin long flat
membrane for 15 cm Rounded laterally
Sharp medial border
Deep to semitendinosus
and biceps Muscle appears half
membranous
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Becomes tendinous Inserted into the posterior surface of medial
condyle of tibia
Three expansions
SemimembranosusMOB TCD
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Expansion downwards and mediallyalong the medial surface of tibia
Upwards and laterally; oblique
popliteal ligament
Which is pierced by middlegenicular vessels and nerve, post
division obturator nerve
Downwards and laterally as fascia
covering popliteus
SemimembranosusMOB TCD
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The Semimembranosus bursa liesbetween 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
SemimembranosusMOB TCD
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Extends hip Flexes and medially and rotates knee
Tibial nerve
SemimembranosusMOB TCD
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Common origin with the long head of thebiceps
Lower medial area of ischial tuberosity
Fleshy fibres of origin replaced by a
tendon Lies in the gutter of semimembranosus
Curves forward
Semitendinosus
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Inserted upper part of subcutaneoussurface of tibia
Behind sartorius and gracilis
Tibial intertendinous bursa
Tibial nerve
SemitendinosusMOB TCD
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Develops from myotomes There is a tendinous
intersection at the junction of
the upper and middle thirds of
the muscle, which is a commonsite of tearsLee and OBrien, 1988
SemitendinosusMOB TCD
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Long head has common originwith the semitendinosus
Lower medial area of ischial
tuberosity
Short head from linea aspera Upper part of lateral
supracondylar line
BicepsMOB TCD
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Inserted into head offibula in front of styloid
process
Folded around lateral
ligament of knee
Long head extends hip
Tibial nerve supplies
long head
Short head by commonperoneal nerve
Both heads flex and
laterally rotates knee
Biceps FemorisMOB TCD
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80% of hamstring strains occur in the occur in the long
head of the biceps femoris muscleKoulouris & Connell, 2003
Injuries may occur:
During the switch between late leg recovery and initial
leg approach in the swing phase of sprintingWoods 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 muscleWoods et al., 2004
Biceps FemorisMOB TCD
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Biceps Femoris
Lack of stiffness and eccentric strength in the short andlong head of the biceps femoris muscle during the
ground contact phase of runningBosch 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 injuryCrosier, 2004
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Hamstrings act eccentrically in theswing 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
HamstringsMOB TCD
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Avulsion of the epiphysisof 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 avulsedIshikawa et al., 1988; Kurosawa et al., 1996
HamstringsMOB TCD
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Poor posture, stiff lumbar spine andweak abdominals, will predispose to
tight hamstrings
Tight hamstrings will shorten the stride
Resulting in a faster work rate over agiven distance but a slower time
Hamstrings used in sprinting and
hurdles
HamstringsMOB TCD
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Triangular area of ischial tuberosity Ramus of ischium
Inserted into medial lip glutealtuberosity
Linea aspera
Medial supracondylar line
Inserted into adductor tubercle
Adductor MagnusMOB TCD
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Adductor portion supplied byposterior 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 MagnusMOB TCD
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Inferior gluteal vessels
Perforating branches of the profunda
artery
Popliteal artery
Blood SupplyMOB TCD
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Leaves through the greater sciaticforamen
Runs vertically down deep to the
biceps on adductor magnus
Divides into tibial and commonperoneal middle of thigh
If it divides in the pelvis common
peroneal pierces piriformis
Sciatic NerveMOB TCD
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Popliteal Fossa
Diamond shaped space
Superomedial boundary
Semimembranosus
Semitendinosis
Superolateral boundary Biceps femoris
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Inferomedial boundary Medial head of gastronemius
Inferolateral boundary
Plantaris
Lateral head of gastronemius
lateral
Popliteal FossaMOB TCD
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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 FossaMOB TCD
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Floor Superior to inferior
Politeal surface of femur
Oblique popliteal ligament
Fascia covering the popliteus
Popliteal FossaMOB TCD
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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 FossaMOB TCD
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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
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Genicular Branches ofMOB TCD
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Genicular Branches of
Popliteal Artery
Superolateral genicular Superolateral genicular
Inferolateral genicular
Inferomedial genicular
Middle genicular pierces oblique poplitealligament
Supplies cruciate ligaments
Branches crucify artery at the back of knee
joint
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Dislocated Knee
Injury to blood vessels mostserious
Loose all blood supply to areas
below the knee
Test for artery first, nerves after
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Popliteal Vein
Union of vena commitans of anterior andposterior tibial arteries
Lower border of popliteus
Ends by becoming femoral vein at hiatus
Tributaries correspond to branches Plus short saphaneous vein
O C
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Tibial Nerve
Bisects middle of fossa superficialto vein and artery
Leaves deep to fibrous arch origin
of soleus
Sural is cutaneous
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Muscular to medial and lateralhead of gastronemius
Plantaris
Soleus
Popliteus Superior, inferior and middle
genicular nerves
Tibial Nerve
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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
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Deep Popliteal Lymph Glands
Superficial lymphatics drain lateral border offoot 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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