flexor compartment of thigh
DESCRIPTION
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MOB TCD
Posterior Compartment of Thigh
Professor Emeritus Moira O’Brien
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
MOB TCD
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Cutaneous Supply
• Posterior cutaneous nerve of thigh S2• Posterior branch of lateral cutaneous of thigh
MOB TCD
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Hamstrings
• Fascia lata thin• Iliotibial tract, thick• Ischial tuberosity• Quadrilateral and
triangular• Sciatic nerve• Extends hip• Flexes knee
MOB TCD
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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
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• Becomes tendinous• Inserted into the posterior surface of medial
condyle of tibia• Three expansions
Semimembranosus MOB TCD
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• 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
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• 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
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• Extends hip• Flexes and medially and rotates knee• Tibial nerve
Semimembranosus MOB TCD
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• 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
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• Inserted upper part of subcutaneous surface of tibia
• Behind sartorius and gracilis• Tibial intertendinous bursa• Tibial nerve
Semitendinosus MOB 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 common site of tears
Lee and O’Brien, 1988
Semitendinosus MOB TCD
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• 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
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• 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
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• 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 muscleWoods et al., 2004
Biceps Femoris MOB TCD
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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 injuryCrosier, 2004
MOB TCD
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• 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
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• 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
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• 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
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• 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
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• 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
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• Inferior gluteal vessels• Perforating branches of the profunda
artery• Popliteal artery
Blood Supply MOB TCD
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• 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
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Popliteal Fossa
• Diamond shaped space• Superomedial boundary• Semimembranosus • Semitendinosis• Superolateral boundary• Biceps femoris
MOB TCD
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• Inferomedial boundary • Medial head of gastronemius• Inferolateral boundary• Plantaris• Lateral head of gastronemius
lateral
Popliteal Fossa MOB 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 Fossa MOB TCD
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• Floor• Superior to inferior• Politeal surface of femur• Oblique popliteal ligament• Fascia covering the popliteus
Popliteal Fossa MOB 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 Fossa MOB 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
MOB TCD
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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
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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
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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
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Tibial Nerve
• Bisects middle of fossa superficial to vein and artery
• Leaves deep to fibrous arch origin of soleus
• Sural is cutaneous
MOB TCD
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• Muscular to medial and lateral head of gastronemius
• Plantaris• Soleus • Popliteus• Superior, inferior and middle
genicular nerves
Tibial Nerve MOB TCD
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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
MOB TCD
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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
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