1. Cover slide

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

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

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

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

6. Semimembranosus Smooth upper lateral portion of ischial tuberosity
MOB TCD
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. Semimembranosus Becomes tendinous
MOB TCD
Becomes tendinous
Inserted into the posterior surface of medial condyle of tibia
Three expansions

8. Semimembranosus
MOB TCD
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. Semimembranosus
MOB TCD
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

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

11. Semitendinosus Common origin with the long head of the biceps
MOB TCD
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. Semitendinosus Inserted upper part of subcutaneous surface of tibia
MOB TCD
Inserted upper part of subcutaneous surface of tibia
Behind sartorius and gracilis
Tibial intertendinous bursa
Tibial nerve

13. Semitendinosus Develops from myotomes
MOB TCD
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. Biceps Long head has common origin with the semitendinosus
MOB TCD
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. Biceps Femoris
MOB TCD
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. Biceps Femoris
MOB TCD
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

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

22. Adductor Magnus
MOB TCD
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. Blood Supply Inferior gluteal vessels
MOB TCD
Inferior gluteal vessels
Perforating branches of the profunda artery
Popliteal artery

24. Sciatic Nerve Leaves through the greater sciatic foramen
MOB TCD
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. Popliteal Fossa Diamond shaped space Superomedial boundary
MOB TCD
Diamond shaped space
Superomedial boundary
Semimembranosus
Semitendinosis
Superolateral boundary
Biceps femoris

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

27. Popliteal Fossa Roof Fascia Lata reinforced by transverse fibres
MOB TCD
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. Popliteal Fossa Floor Superior to inferior Politeal surface of femur
MOB TCD
Floor
Superior to inferior
Politeal surface of femur
Oblique popliteal ligament
Fascia covering the popliteus

29. Contents of Popliteal Fossa
MOB TCD
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. Popliteal Artery Deepest structure which lies on floor
MOB TCD
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
MOB TCD
Superolateral genicular
Inferolateral genicular
Inferomedial genicular
Middle genicular pierces oblique popliteal ligament
Supplies cruciate ligaments
Branches crucify artery at the back of knee joint

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

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

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

36. Common Peroneal Nerve May pierce piriformis
MOB TCD
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. Deep Popliteal Lymph Glands
MOB TCD
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

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