Back of Thigh

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Back of Thigh Popliteal Fossa

• Dr. Mujahid Khan

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Skin Cutaneous Nerves

• The posterior cutaneous nerve of thigh is a
  branch of the sacral plexus
• Leaves the gluteal region by emerging from
  beneath the lower border of the gluteus maximus
• Descends on the back of thigh
• In the popliteal fossa it pierces the deep fascia
  and supplies the skin
• Gives off branches to the skin on the back of the
  thigh and upper part of leg

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Superficial Veins

• Many small veins curve around the medial and
  lateral aspects of the thigh
• They drain into the great saphenous vein
• Superficial veins form in the lower part of the
  back of thigh join small saphenous vein in the
  popliteal fossa
• Lymph from the skin and superficial fascia drain
  into the vertical group of superficial inguinal
  lymph nodes

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Contents

• Muscles Biceps femoris, semitendinosus,
  semimembranosus, and a small part of the adductor
  magnus
• Blood Supply Branches of the profunda femoris
  artery
• Nerve Supply Sciatic Nerve

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Biceps Femoris

• Origin The long head from the ischial tuberosity
• Short head from the linea aspera and the lateral
  supracondylar ridge of the shaft of the femur
• Insertion Two heads unite just above the knee
  joint and insert into the head of the fibula
• Nerve Supply Long head by the tibial part of the
  sciatic, short head by the common peroneal part
  of sciatic
• Action Flexes and laterally rotates the leg at
  the knee joint, long head extends the thigh at
  the hip joint

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Semitendinosus

• Origin From the ischial tuberosity
• Insertion By a long tendon into the upper part
  of the medial surface of the shaft of the tibia
• Nerve Supply The tibial portion of sciatic nerve
• Action Flexes and medially rotates the leg at
  the knee, extends the thigh at the hip joint

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Semimembranosus

• Origin From the ischial tuberosity
• Insertion Into the posteromedial surface of the
  medial condyle of the tibia
• It sends a fibrous expansion on the back of the
  knee joint called oblique popliteal ligament
• Nerve Supply Tibial part of the sciatic nerve
• Action Flexes and medially rotates the leg at
  the knee joint, extends thigh at the hip joint

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Adductor Magnus (Hamstring Portion)

• Origin Ischial tuberosity
• Insertion Adductor tubercle of femur
• Nerve Supply Tibial portion of sciatic nerve
• Action Extends thigh at hip joint

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Blood Supply

• The four perforating branches of the profunda
  femoris artery provide a rich blood supply to
  this compartment
• The profunda femoris vein drains the greater part
  of the blood from the compartment

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Sciatic Nerve

• It is a branch of sacral plexus
• It leaves the gluteal region as it descends in
  the midline of the thigh
• It is overlapped posteriorly by the adjacent
  margins of the biceps femoris and semimembranosus
  muscles
• It lies on the posterior aspect of the adductor
  magnus muscle

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Sciatic Nerve

• In the lower third of the thigh it ends by
  dividing into the tibial and common peroneal
  nerves
• Occasionally, the sciatic nerve divides into its
  two terminal parts at a higher level, in the
  upper part of the thigh, the gluteal region, or
  even inside the pelvis

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Branches of Sciatic Nerve

• Tibial Nerve It enters the popliteal fossa
• Common Peroneal Nerve It enters the popliteal
  fossa on the lateral side of the tibial nerve
• Muscular Branches To the long head of the biceps
  femoris, the semitendinosus, the semimembranosus,
  and the hamstring part of the adductor magnus,
  These branches arise from the tibial component
  and run medially

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Popliteal Fossa

• Popliteal fossa is a diamond-shaped intermuscular
  space situated at the back of the knee
• It is more prominent when the knee is flexed
• It contains the popliteal vessels, the small
  saphenous vein, the common peroneal and tibial
  nerves, the posterior cutaneous nerve of the
  thigh, the genicular branch of the obturator
  nerve, connective tissue and lymph nodes

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Boundaries of Popliteal Fossa

• Laterally Biceps femoris above and the lateral
  head of gastrocnemius and plantaris below
• Medially the semimembranosus and the
  semitendinosus above and the medial head of the
  gastrocnemius below

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Boundaries of Popliteal Fossa

• The anterior wall or floor of the fossa is formed
  by the popliteal surface of the femur, the
  posterior ligament of the knee joint, and the
  popliteus muscle
• The roof is formed by skin, superficial fascia,
  and the deep fascia of the thigh

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Popliteus Muscle

• Origin From the lateral surface of the lateral
  condyle of the femur by a rounded tendon and by a
  few fibers from the lateral semilunar cartilage
• Insertion Posterior surface of tibia, above the
  soleal line
• It arises within the capsule of the knee joint
  and emerges through the lower part of the capsule
  of the joint

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Popliteus Muscle

• Nerve Supply Tibial nerve
• Action Medial rotation of the tibia on the femur
• If the foot is on the ground, lateral rotation of
  the femur on the tibia
• This action is also called unlocking of the knee
  joint

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Popliteal Artery

• The popliteal artery is deeply placed
• It is a continuation of the femoral artery
• It enters the popliteal fossa through the opening
  in the adductor magnus
• It ends at the level of the lower border of the
  popliteus muscle by dividing into anterior and
  posterior tibial arteries

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Relations of Popliteal Artery

• Anteriorly The popliteal surface of the femur,
  the knee joint, and the popliteus muscle
• Posteriorly The popliteal vein and the tibial
  nerve, fascia and skin
• Branches Muscular branches and articular branches

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Popliteal Vein

• The popliteal vein is formed by the junction of
  the venae comitantes of the anterior and
  posterior tibial arteries
• Forms at the lower border of the popliteus muscle
• On the medial side of the popliteal artery
• It passes through the opening in the adductor
  magnus to become the femoral vein

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Tributaries of Popliteal Vein

• Veins that correspond to branches given off by
  the popliteal artery
• Small saphenous vein, perforates the deep fascia
  and passes between the two heads of the
  gastrocnemius muscle to end in the popliteal vein

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Arterial Anastomosis Around Knee Joint

• To compensate for the narrowing of the popliteal
  artery which occurs during extreme flexion of the
  knee
• Around the knee joint a profuse anastomosis of
  small branches of the femoral artery is present
• It is joined by the muscular and articular
  branches of the popliteal artery and with
  branches of the anterior and posterior tibial
  arteries

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Popliteal Lymph Nodes

• About six lymph nodes are embedded in the fatty
  connective tissue of the popliteal fossa
• They receive superficial lymph vessels from the
  lateral side of the foot and popliteal fossa
• They also receive lymph from the knee joint and
  from deep lymph vessels accompanying the anterior
  and posterior tibial arteries

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Tibial Nerve

• It is the larger terminal branch of the sciatic
  nerve
• It arises in the lower third of the thigh
• It runs downward through the popliteal fossa
• Lying first on the lateral side of the popliteal
  artery then posterior to it
• It enters the posterior compartment of the leg by
  passing beneath the soleus muscle

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Branches of Tibial Nerve

• Cutaneous Usually joined by the sural
  communicating branch
• Muscular Supply both heads of the gastrocnemius
  and plantaris, soleus and popliteus
• Articular Supply the knee joint

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Common Peroneal Nerve

• It is a smaller terminal branch of the sciatic
  nerve
• Arises in the lower third of the thigh
• Runs downward through the popliteal fossa
• Leaves the fossa by crossing superficially to the
  lateral head of the gastrocnemius muscle

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Common Peroneal Nerve

• Passes behind the head of the fibula
• Winds around the neck of fibula
• Pierces the peroneus longus muscle
• Divides into two terminal branches the
  superficial peroneal and deep peroneal nerves
• It is subcutaneous and can be rolled against the
  neck of the fibula

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Branches of Common Peroneal Nerve

• Cutaneous sural communicating branch, the
  lateral cutaneous nerve of the calf supplies the
  lateral side of the back of the leg
• Muscular supply to the short head of biceps
  femoris
• Articular branches to the knee joint