Functional Anatomy Lower Extremity Posterior Thigh PDF

Functional Anatomy Lower Extremity: Posterior Thigh Jason Dring, PT, DPT Contributions By: E. Costello, PT, PhD, Joe Signorino, PT, DPT  Cluneal Nerves Superior cluneal nerves are located superior to the iliac crest (these are lumbar dorsal rami) Med...

Functional Anatomy Lower Extremity: Posterior Thigh Jason Dring, PT, DPT Contributions By: E. Costello, PT, PhD, Joe Signorino, PT, DPT  Cluneal Nerves Superior cluneal nerves are located superior to the iliac crest (these are lumbar dorsal rami) Medial (or middle) cluneal nerves which are near the sacrum at the midline (these are sacral dorsal rami) Inferior cluneal nerves which are found inferior to the glut maximus inferior border (these are sacral ventral rami)  Organization of the Thigh  Organized into 3 compartments by intermuscular septa  Includes: anterior, medial, & posterior  Posterior Thigh Muscles  Function: extension at hip and flexion at knee  Includes: hamstrings https://upload.orthobullets.com/topic/1063/images/thigh %20compartments%20master.jpg Bursa in the Region Bursa: located in areas that are subject to friction; membranous sacs lined with synovial membrane 1. Ischial - separates the glut max from ischial tuberosity 2. Iliopsoas - separates joint from muscle 3. Trochanteric - separate glut max from greater trochanter 4. Gluteofemoral - separates the iliotibial band from superior portion of vastus lateralis (next slide) Gluteofemoral Bursa  Hamstring Musculature  Semitendinosus  From: the ischial tuberosity  To: the medial surface of superior tibia (pes ancerinus, “SGT”)  Semimembranosus  From: the ischial tuberosity  To: the posterior part of medial tibial condyle & a reflected attachment to the oblique popliteal ligament (Semimembranosus and oblique popliteal ligament = remember “SMOP”)  Biceps Femoris  From:  long head - the ischial tuberosity  short head - the linea aspera & lateral supracondylar line of the femur  To: Long and short heads insert distally to lateral head of fibula Semitendinosus From: the ischial tuberosity To: the medial surface of superior tibia (pes ancerinus) (not shown, next slide) x x Semimembranosu s From: the ischial tuberosity To: the posterior part of medial tibial condyle & reflected x Insertio attachment (oblique x n popliteal ligament/SMOP) x x Biceps Femoris long head: from the ischial tuberosity short head: from x the linea aspera & lateral supracondylar line Semitendinosus From: the ischial tuberosity To: the medial surface of superior tibia (pes ancerinus) Semimembranosu s From: the ischial tuberosity To: the posterior part of medial tibial condyle & reflected attachment (oblique popliteal ligament/SMOP) Biceps Femoris long head: from the ischial tuberosity short head: from the linea aspera & lateral supracondylar line of the femur x To: both insert x  BFL ST SM B F S Insertion on Ischial Tuberosity: - Semitendinosu s - Semimembran osus - Biceps Femoris – long head Oblique popliteal ligament  Hamstrings cont. AXN: – Semimembranosus/ Semitendinosus Extends the hip Flexes knee Medially rotates leg Extends trunk if in closed kinematic chain – Biceps Femoris long & short heads Extends the hip (long head only) Flexes knee Laterally rotate leg Innervation: Biceps femoris long head (L5, S1, S2), Semimembranosus (L5, S1, S2), Semitendinosus (L5, S1, S2) - Tibial portion of sciatic N. Innervation: Biceps femoris short head: Common (fibular) peroneal portion of sciatic N. (L5, S1, S2)  s e m i m e m x x “Say Grace before Tea” or Sergeant = SGT *Note how semimembranosus embeds with joint cap/MCL – and then medial meniscus! Plantaris Medial Lat Head Head Gastroc Gastroc Obliqu e Arcuate Poplite Popliteal al Ligament Ligame nt SMO P Biceps Semimembranos Femoris us Popliteus  Iliotibial Tract Fibular Collateral Ligament Jt capule Biceps Femoris  Popliteal Fossa diamond shaped depression in posterior aspect knee superiorly bounded by the hamstrings plantari Medial s Lateral inferiorly bounded by the 2 heads of the gastrocnemius & plantaris muscles posteriorly by skin & fascia anteriorly by popliteal surface of femur, oblique popliteal ligament, popliteal fascia over popliteus Nerves Plantaris m. Medial Sural Lateral n. Sural n.  Plantaris m  From: inferior Popliteus m end of lateral supracondylar line of femur & oblique popliteal “Fool’s nerve” ligament or “Freshman’s nerve”  To: posterior surface of calcaneus via calcaneal tendon  Popliteal Fossa Contents Popliteal Arteries & Veins (deeper) Lesser Saphenous Vein (superficial) Tibial & Common Peroneal Nerves (Med/Lat Sural Nerves; Sural Nerve) Posterior femoral cutaneous n. – inn. skin overlying fossa Lesser Saphenous Vein Popliteal lymph nodes & lymphatic vessels Popliteal v When the femoral Popliteal a artery passes through the adductor hiatus it changes to the popliteal artery