Download The popliteal vessels

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 over the
anterior border of gluteus maximus while
elsewhere is thin. It continuous below with
the fascia lata and attached to the iliac
crest above.
Cutaneous nerves of the gluteal region
• 1- lateral cutaneous branches from subcostal (T12) and
iliohypogastric
nerve(L1)
supply
the
upper
lateral
quadrant of the buttock.
• 2-The lower lateral quadrant is supplied by the lateral
cutaneous nerve of the thigh(L2,L3).
• 3- The lower medial quadrant supplied by the posterior
cutaneous nerve of the thigh which curve over the lower
border of gluteus maximus (inferior cluneal nerve).
• 4- The upper medial quadrant supplied by the lateral
cutaneous branches from dorsal rami L1-L3 (superior
cluneal nerves) and the lateral cutaneous branches of
the dorsal rami of S1-S3 (middle cluneal nerves)
• The perforating cutaneous nerve (S2,3) of the sacral
plexus, pierces the sacrotuberous ligament and gluteus
maximus mid way between coccyx and ischial tuberosity.
Cutaneous nerves of the gluteal
region
• 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. The lateral edge of the
ligament forms the posteromedial border of the
greater and lesser sciatic notches.
Sacrotuberous ligament
• 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.
Sacrospinous ligament
• Sciatic foramina
• The greater sciatic foramen: bounded by the
greater sciatic notch of the hip bone the
sacrotuberous ligament and the sacrospinous
ligament, it transmit structures from the pelvis to
the gluteal region.
• The lesser sciatic foramen: bounded by
the
lesser
sacrospinous
sciatic
and
notch
and
the
sacrotuberous
ligaments, it transmits structures between
the gluteal region and the perineum.
Structures which enter the gluteal
region from the pelvis
• 1- Remain in the gluteal region these include;
the gluteal vessels and nerves and the piriformis
muscle.
• 2- Descend from the gluteal region into the back
of the thigh include; the sciatic nerve, the
posterior cutanous of the thigh and branches of
the inferior gluteal vessels.
• 3- Turn forwards through the lesser sciatic
foramen into the perineum include; the
internal pudendal vessels, pudendal nerve
and nerve to obturator internus muscle.
Muscles of the gluteal region
• The large muscles include: Gluteus
maximus, medius and minimus.
• The small muscles include: piriformis,
obturator internus, superior and inferior
gemelli and quadratus femoris.
Large muscles of the gluteal region
Small muscles of gluteal region
Piriformis muscle
• it is a land mark muscle in the gluteal region. It is
conical muscle arise in the pelvis from the pelvic
surface of the middle three pieces of the sacrum,
It passes through the greater sciatic foramen to
be inserted in the upper border of the greater
trochanter of the femur.
• Nerve supply from the first and second sacral
nerves.
Gluteal vessels
• Include
• Inferior gluteal artery
• Superior gluteal artery
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 cutaneous branches
to the buttock and the back of the thigh, it also
give a slender companion artery to the sciatic
nerve.
Superior gluteal artery
arise from the internal iliac artery accompany the
superior gluteal nerve, it enters the gluteal region
above the piriformis muscle. It divided into
• Superficial branch passes between the gluteus
maximus and piriformis muscles.
• Deep branch follow the superior gluteal nerve
supply the gluteus medius, minimus and the hip
joint.
Gluteal vessels and nerves
Nerves of the gluteal region
• 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.
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 and 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).
Sciatic nerve
Anastomosis between branches from the
internal and external iliac arteries
• 1- between medial circumflex femoral artery
and
• a- obturator artery.
• b- Both gluteal arteries.
• c- Lateral circumflex artery.
• d- perforating branches of the profunda artery.
• 2-
Between The superior gluteal artery
and
• a- lateral circumflex artery.
• b- Superficial circumflex iliac artery.
• 3- between internal pudendal artery, deep
and superficial external pudendal arteries
of the femoral artery.
The back of the thigh
(the posterior compartment)
• 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.
posterior cutanous nerve of the thigh
• which is a branch of the sacral plexus enters the
thigh inferior to the piriformis muscle through the
greater sciatic foramen. it descend through the
posterior midline of the thigh giving small
branches from both sides to the skin of the back
of the thigh and the popliteal fossa, it pierce the
fascia lata and ends as a cutaneous branches
over the calf.
Posterior cutaneous nerve of the
thigh
• The
blood
supply
of
the
posterior
compartment are the perforating branches
from the profunda femoris artery.
The popliteal fossa
• It lies behind the knee, the lower 1/3 of the
femur and the upper part of the tibia. It is
diamond in shape.
• The superficial fascia of the fossa contain
little fat, while the deep fascia is thin,
strong and firmly attached to the tendons.
• Bounderies:
• Upper lateral --------- biceps femoris m.
• Upper medial--------- semimembranosus and
semitendinosus ms.
• Lower lateral and medial--------- the 2 heads of
the gastrocnemius m.
• The anterior wall is the popliteal surface of the
femur, the posterior capsule of the knee joint
and the fascia of the popliteus m.
• The posterior wall is the deep fascia of the fossa.
Contents of the fossa
• These include:
• 1- The popliteal vessels.
• 2- Branches of the sciatic nerve, the tibial
and common peroneal nerves.
• 3- Popliteal lymph nodes.
• 4- Posterior cutaneous nerve of the thigh.
Contents of the fossa
The popliteal vessels
These are the direct continuation of the
femoral vessels enter the fossa through the
adductor hiatus. They lie anterior to the tibial
nerve, the common peroneal nerve pass
laterally accompany the tendons of the biceps
muscle. The popliteal artery ends at the lower
border of the popliteus muscle by dividing into
anterior and posterior tibial arteries.
The popliteal artery
• begin at the adductor hiatus and ends at
the lower border of the popliteus m. where
it divided into anterior and posterior tibial
arteries. The popliteal artery is anterior to
the semimembranosus m. Popliteal vein,
tibial
nerve,
the
heads
gastrocnemius and plantaris ms.
of
the
The popliteal artery
• Branches:
• 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
then 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.
Tibial nerve
Branches in the popliteal fossa
• 1- 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 join the
peroneal
communicating
branch
from
the
peroneal nerve, 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.
• 2-
Muscular
gastrocnemius,
branches
plantaris,
to
soleus
the
and
popliteus ms.
• 3-
Articular
branches,
it
gives
superomedial, inferomedial and middle
genicular branches to the knee joint,
accompanied the corresponding branches
from the popliteal artery
Common peroneal nerve (L4 L5 S1 S2)
• It is smaller than tibial nerve runs 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 to join the sural
nerve about the middle of the back of the leg, it
supply the proximal 2/3 of the posterolateral part
of the leg.
• Lateral cutaneous nerve of the calf arise
on the lateral head of the gastrocnemius m.
supply the lateral side of the leg.
• 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.
•