Flexor Compartment of Thigh BMJ

7/28/2019 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



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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



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Extends hip Flexes and medially and rotates knee

Tibial nerve



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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


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Floor Superior to inferior

Politeal surface of femur

Oblique popliteal ligament

Fascia covering the popliteus


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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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Flexor Compartment of Thigh BMJ