Download Branches in the popliteal fossa

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Gluteal region
.Extends from the iliac crest above to the gluteal fold below
The superficial fascia is thick dense and fatty, the deep fascia is thick
It continuous below with the fascia lata,.
Sacrotuberous ligament:
It is a strong band passes upwards from the medial side of the ischial
tuberosity to the margins of the sacrum and coccyx and to both posterior
iliac spines.
Sacrospinous ligament:
This is a thick triangular band it passes from the the ischial spine to the
margin of coccyx and last piece of the sacrum deep to the sacrotuberous
ligament.
These two ligaments share together to conver greater and lesser Sciatic
notcges into foramina
The greater sciatic foramen:. Transmits Structures which enter the
gluteal region from the pelvis which include
1-Superior gluteal vessels and nerves.
2-the piriformis muscle
3-.inferior gluteal vessels and nerves
4-sciatic nerve,
5-the posterior cutanous of the thigh
6-pudendal nerve
7—nerve to quadrates femoris
The lesser sciatic foramen:, transmits structures between the gluteal
region and the perineum these include; the internal pudendal
vessels, pudendal nerve and nerve to obturator internus muscle.
Muscles of the gluteal region: The muscles of the gluteal region can be
divided into two groups:

Superficial group – a group of large muscles that abduct and
extend the femur. It includes the gluteus maximus, gluteus medius,
gluteus minimus and tensor fascia lata.

Deep lateral rotators – A group of smaller muscles, that mainly
act to laterally rotate the femur. It includes the quadratus femoris,
piriformis, gemellus superior, gemellus inferior and obturator
internus and obturator externus.
.
Names of m.
origin
insertion
Tensor Fascia Lata
anterior
iliac
crest,
attaching to the anterior
superior iliac spine
a.Area
behind
the
posterior gluteal line
b.back of sacrum and
coccyx
c.back of sacrotuberous
lig.
Area between middle
and inferior gluteal line
iliotibial tract,
Gluteus maximus
Gluteus minimus
Gluteus medius
a.3/4 inserted into
ilio-tibial tract
b.1/4to
gluteal
tuberosity
Front of greater
trochanter
Area bounded by iliac Greater
crest,posterior
and trochanter
middle gluteal lines
Action. Gl. Maximus is main extensor at hip joint assist in raising
from sitting position and a powerful muscle on climbing
Gl. Medius and minimus and tensor fasia lata are abductors and
medial rotation of thigh at hip
Nerve supply
Inferior gluteal nerve (L5 S1 S2): it is a branch from the sacral plexus
enter the gluteal region with the posterior cutanous nerve of the thigh
inferior to the piriformis m. supply gluteus maximus m.
Superior gluteal nerve (L4 L5 S1): it is a branch from the sacral plexus
enters the gluteal region above the piriformis m. divided into numbers of
branches supply the glueus medius , minimus and tensor fasciae lata m.
Gluteal vessels
Include:
Inferior gluteal artery: it is a branch of the internal iliac artery
emerges from the pelvis below piriformis muscle accompany the
inferior gluteal nerve supply the gluteus maximus and gives branches
to the back of the thigh, it also give a slender companion artery to the
sciatic nerve. The inferior gluteal artery anastomosed with the medial
circumflex artery.
Superior gluteal artery: arise from the internal iliac artery accompany
the superior gluteal nerve, it enters the gluteal region above the
piriformis muscle. It follows the superior gluteal nerve supply the
gluteus medius, minimus and the hip joint.
In addition gluteal region has the following small and short muscles
which are located deeply
Names of m.
Origin
Piriformis
Inferior gemellus
Middle three peices Upper
border
of
of the front of sacrum greater trochanter and
trochanteric fossa
Pelvic surface of trochanteric fossa just
obtur. Membrane
inferior to insertion of
piriformis
Both
insertion
Ischial spine and together with that of
upper
border
of obturator internus m.
ischial tuberosity
into trochanteric fossa
Quadrates femoris
Ischial tuberosity
Guadrate tubercle
Obturator externus
Outer surface
obtur. Membrane
of trochanteric fossa
Obturator internus
Superior gemellus
insertion
All these short muscles are lateral rotaters of the thigh at the hip joint.
N. supply 1)-sup.gemellus+obtu. Intr.by nerve to obtu. Int.2)inferior
gemellus+ quadrates femoris by nerve to quadratus femoris
3)piriformis by branches from S1andS2. 4) obtu. Exter. By obturater
nerve
The back of the thigh
lec5
The muscles of the back of the thigh are the hamstring muscles
which are extensors of the hip joint and flexors of the knee joint, all
arise from the ischial tuberosity except the short head of the biceps m.
and all are inserted in the bones of the leg.
These muscles include: biceps femoris, semitendinosus and
semimembranosus. All supplied by the sciatic nerve.
Names of m.
origin
Biceps femoris
insertion
a-long head has common
origin
with
semitendinossus
from
ischial tuberosity
b-short head from linea
aspira
semitendinosus
has common origin with
long head of biceps from
ischial tuberosity
semimembranousus from ischial tuberosity
By common tendone
to the head of fibula
Ischial part of from ischial tuberosity
adductor magnus
Adductor tubercle of
femor
Upper part of medial
sureface of tibia
Posteromedial part
of medial condyle of
tibia
Action hamstring muscles are extensors of the hip joint and flexors of
the knee joint. In addition both semiten.and semimem.act as medial
rotaters of leg when knee joint semiflexed.biceps femoris act as lateral
rotater of leg when knee joint semiflexed.
Sciatic nerve (L4 L5 S1 S2 S3): it is the thickest nerve in the body
arise from the sacral plexus, pass inferior to the piriformis m through
the greater sciatic foramen, deep to the gluteus maximus m. in the
upper part of its course it descends over:
1- ischial wall of the acetabulum.
2- Obturator internus m. and the 2 gemelli ms.
3 -Quadratus femoris m.
It leaves the buttock by passing deep to the long head of the biceps
femoris, it supply the hamstring ms from the tibial side of the nerve
except the short head of biceps muscle receive its nerve supply from
the common peroneal side, it also gives articular branch to the hip
joint. the sciatic nerve then descends on the posterior surface of the
adductor magnus m. at the lower third of the thigh it divided into
medial branch (tibial nerve) and lateral branch (common peroneal
nerve).
The popliteal fossa
It is a diamond shaped space ( depression) lies behind the knee, the
lower 1/3 of the femur and the upper part of the tibia.
The superficial fascia of the fossa contain little fat, while the deep fascia
is thin and strong
Bounderies:
superolaterally --------- biceps femoris m.
superomedially--------- semimembranosus and semitendinosus ms.
inferolaterally -------- lateral head of the gastrocnemius m.
Inferomedially …………. Medial head of the gastrocnemius m.
The anterior wall ( floor) : from above downward is the popliteal
surface of the femur, popliteus m the posterior capsule of the knee joint
and oblique popliteal ligament
The posterior wall ( roof) is the skin and deep fascia of the fossa.
Contents of the fossa
These include:
1- The popliteal vessels. The popliteal art. is most anteriorly , it
gives 5 genicular branches in the fossa and bifurcates at
lower border of popliteus m. into anterior and posterior tibial
arteries
2- Branches of the sciatic nerve the tibial and common peroneal
nerves.
3- Popliteal lymph nodes.
4- Posterior cutaneous nerve of the thigh.
The popliteal artery
These are the direct continuation of the femoral art. enter the
fossa through the adductor hiatus. They lie anterior to the tibial
nerve,. it lies aganist the posterior part of the capsule of the
knee joint, then it lies posterior to popliteus muscle in the upper
part of the leg.The popliteal artery ends at the lower border of
the popliteus muscle by dividing into anterior and posterior
tibial arteries.
Branches of popliteal artery:
1- muscular branches to the hamstring ms. And to the muscles
of the calf.
2- Articular branches these are the lateral and medial superior
and inferior genicular and middle genicular arteries to the
knee joint correspond to the genicular branches from the
tibial and common peroneal nerves. they anastomosed with
the branches from the lateral circumflex femoral, descending
genicular arteries, and the recurrent branches of the anterior
tibial artery.
The popliteal vein: formed by the union of the anterior tibial, the
posterior tibial and the peroneal veins at the lower border of the popliteus
muscle, it lies superficial to the artery and between it and the tibial nerve.
it receive tributaries correspond to the branches of the popliteal artery and
the lesser saphenous vein. it become the femoral vein at the adductor
hiatus.
Tibial nerve (L4 L5 S1 S2 S3).
It is the largest of the two terminal branches of the sciatic nerve, it
begins above the popliteal fossa descends vertically in the fossa, Lying
first on the lateral side of the popliteal artery then posterior to it and
finally medial to it. it pass between the two heads of the gastrocnemius
muscle and under the soleus muscle. It supply the muscles of the back of
the thigh and leg, the sole of the foot, the skin of the lateral and lower half
of the back of the leg and sole of the foot.
Branches in the popliteal fossa:
1-- Articular branches, it gives superomedial, inferomedial and middle
genicular branches to the knee joint, accompanied the corresponding
branches from the popliteal artery
2-Muscular branches to the muscles of the back of the thigh and to the
gastrocnemius, plantaris, soleus and popliteus ms.
3-sural nerve: it is a cutaneous branch descend in the groove between the
two heads of the gastrocnemius m. it pierce the deep fascia about the
middle of the back of the leg, supply the skin of the lower posterior part
of the leg and the skin of the lateral side of the dorsum of the foot. It
accompany the small saphenous vein.
Common peroneal nerve (L4 L5 S1 S2)
It is smaller than tibial nerve follow the tendon of biceps femoris m.
along the upper lateral border of the popliteal fossa to the back of the
head of the fibula, then curves forwards along the neck of the fibula deep
to the peroneus longus m. here it divides into deep and superficial
branches.
Branches in the popliteal fossa:
1- cutaneous branches, these include the peroneal communicating
branch which arise in the upper part of the popliteal fossa descend on
the posterolateral side of the calf , it supply the proximal 2/3 of the
posterolateral part of the leg.
Lateral cutanous nerve of the calf arise on the lateral head of the
gastrocnemius m. supply the lateral side of the leg.
2- articular branches, these include: the superior and the inferior
lateral genicular branches they are small branches accompany the
corresponding arteries.
Recurrent genicular branch arise where the common peroneal
nerve divides into superficial and deep branches, it ascends to the
knee joint.
3- muscular branch to the short head of the biceps femoris m. arise
high up in the fossa.
Hip joint: it is a synovial joint of ball and socket type, the joint
formed between the head of the femur and the acetabulum, the articular
surface of which is horseshoe shaped and is deficient inferiorly at the
acetabular notch. The cavity of the acetabulum is deepened by the
presence of a fibrocartilaginous rim called the acetabular labrum, the
labrum is connected across the acetabular notch by the transverse
acetabular ligament. The strength and stability of the joint depend on :
1- depth of the acetabulum which increased by the labrum acetabulae.
2- The strong ligaments and muscles surrounding the joint.
The fibrous capsule which surrounds the joint attached to the
margin of the acetabulum and transverse ligament proximally. Distally
attached to the intertrochantric line and greater trochanter anteriorly
and intertrochantric crest posteriorly. The fibrous capsule is lined by
the synovial membrane.
Ligaments of the joint:
1- iliofemoral ligament is a strong ligament lie in the front of the
joint. it is inverted Y shaped.it prevents hyperextens of the hip
joint.
2- Pubofemoral ligament it is triangular ligament lie in the lower
anterior part of the capsule.) it limits abduction)
3- Ischiofemoral ligament it is lie posteriorlyl.) limit extension)
4- The transverse acetabular ligament it converts the notch into a
tunnel through which the blood vessels and nerves enter the joint.
5-Ligaments of the head of the femur it is attached to the pit on the
head of the femur and by its base to the transverse acetabular
ligament.
Blood supply of the joint
1- branch from lateral and medial circumflex femoral artery.
2- Acetabular branches of the obturator.
3- Branches of the superior and inferior gluteal artery.
Nerves of the joint
1- nerve to quadratus femoris.
2- The femoral nerve through nerve to rectus femoris.
3- Anterior division of the obturator nerve.
Movement at hip joint:
1- flexion which is very free it produced mainly by iliopsoas, assisted
by rectus femoris and sartorius.
2-Extension (restricted by the iliofemoral ligament.(it produced
mainly by glut. Maximus m. assited by hamstring m.
3- Abduction (restricted by the pubofemoral ligament.) it produced
mainly glut. Medius and minimus assited by Sartorius and tensor
fascia latae.
4- Adduction is (restricted by the lateral portion of the iliofemoral
ligament). it produced mainly by 3 adductor m. assisted by
pectineus and gracilis
5- Medial rotation (tightens the ischiofemorall ligament). it produced
mainly by glut. Medius and minimus assited by tensor fascia latae.
6-Lateral rotation is( limited by the pubofemoral ligament and the
lateral part of the iliofemoral ligament.) it produced mainly by deep
glut. M.