Posterior region of lower limb

(Thigh & leg)

Department of Anatomy and Cell Biology

Bor-Chyuan Su
[email protected]/3253

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 Review

Gluteus medius m. (cut)

Gluteus maximus m. Superior gluteal a.

Gluteus minimus m.
Superior gluteal n.
Piriformis m.
Inferior gluteal a.
Pudendal n. & Superior gemelleus m. &
Internal pudendal a. Obturator internus m.
Inferior gemelleus m.
Sciatic n.
Quadratus femoris m.
Muscle:
Gluteus maximus, medius, minimus
Posterior cutaneous n. Priformis, superior & inferior gemelleus, obturator internus,
quadratus femoris m.
of the thigh Vessels:
Superior (under medius) and inferior gluteal v; internal
pudendal a.
Nerve:
Sciatic n., posterior cutaneous n. of the thigh.,2pudendal n.
Posterior Compartment of the Thigh

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Posterior cutaneous n. of the thigh CUT
Sciatic n.
Dissection
1. Open the fascia lata widely

Posterior cutaneous nerve of the thigh

• Courses deep to the fascial lata
• Sends cutaneous branches through the fascia lata to the
posterior surface of the thigh
Sciatic nerve
• Courses as far as the knee where it branches into the tibial
and common fibular n.

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Biceps femoris m.
• Long head of the biceps femoris m.
• Retract the long head of the biceps femoris m.
laterally to observe the short head of the
biceps femoris m.
• Short head of the biceps femoris m.
Long head of the
biceps femoris m.
• Innervation by 2 n.
• Long head – by the tibial division of the sciatic n.
• Short head – by the common fibular division of
the sciatic n.

Short head
Long head

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Biceps femoris m. Flexion

Extension

Long head of the biceps femoris m.

Superior attachment Inferior attachment Action
Extends the thigh & Flexes
Ischial tuberosity Head of the fibula
the leg
Short head of the biceps femoris m.
Superior attachment Inferior attachment Action
The tendon of the short head of the biceps
Lateral lip of the linea aspera Extends the thigh & Flexes
femoris muscle joins the tendon of the long
of the femur the leg
head and it attaches on the head of the fibula 6
Semitendinosus m.
• On the medial side of the thigh
• “half tendon” m.
• Named for the long, cord-like tendon at its inferior end
• Innervated by:
• Tibial division of the sciatic n.

Ischial tuberosity

Tibia

Semitendinosus m.
Superior attachment Inferior attachment Action
Extends the thigh &
Ischial tuberosity Medial surface of the superior part of the tibia
Flexes the leg7
Semimembranosus m. CUT
• “half membrane” m.
• Named for the broad, membrane-like tendon at its superior end
• Innervated by:
• Tibial division of the sciatic n.
• Dissection
• Use your fingers to separate the semitendinosus m. from the
semimembranosus m.

Ischial tuberosity

Tibia

Semimembranous m.
Superior attachment Inferior attachment Action
Extends the thigh &
Ischial tuberosity Posterior part of the medial condyle of the tibia
Flexes the leg8
 Adductor Thigh
Gracilis m. Medial  Lateral
magnus m.
Semimembranosus m. Biceps
femoris m.
Iliotibial tract
Semitendinosus m. Long head 
short head

Semitendinosus m.

Semimembranosus m.

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Adductor magnus m.
• Medial compartment of the thigh
• Forms the anterior boundary of the posterior compartment of the thigh

Anterior view Posterior view

Adductor magnus m.
Superior attachment Inferior attachment Action
Adduction of hip
Ischial tuberosity Adductor tubercle on the medial femoral condyle Flexion of hip
Extension of 10
hip
Sciatic n.
• Through the posterior compartment of the thigh to the area behind the knee
• Supplies unnamed muscular branches to the posterior thigh m.
• Its named branches (tibial and common fibular division of sciatic n.)

• Typically divides at the level of the knee

• But this division may occur more superiorly
• Either in the thigh or in the gluteal region

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Popliteal fossa
Superior

Medial Lateral

Inferior

Direction Muscle (structures)

Superolateral Biceps femoris m.
Superomedial Semitendinosus & Semimembranosus m.
Inferolateral Lateral head of the gastrocnemius m. & Plantaris m.
Inferomedial Medial head of the gastrocnemius m.
Posterior Skin & deep (popliteal) fascia
Popliteal surface of the femur
Anterior Posterior surface of the capsule of the knee joint
Popliteus m. 12
 Superior
Popliteal fossa
Medial Lateral

Inferior

Pronunciation
• Gastrocnemius m.
• Plan‛taris m.
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Popliteal fossa CUT
• Sciatic n.
• Divides into the (At the superior border of the popliteal
fossa)
• Tibial n.
• Common fibular n.
• Laterally along the superolateral border of the
popliteal fossa
• Parallels the biceps femoris tendon
• Popliteal a. & v.
• The popliteal a. & v.
• Deep to the tibial n.
• Enclosed by a connective tissue sheath
• Separate the popliteal a. from the popliteal v.
• Preserve the popliteal v. but remove its tributaries
to clear the dissection field

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Dissection
1. Remove the remnants of the deep fascia (popliteal fascia) to expose the medial &
CUT
lateral heads of the gastrocnemius m.
2. Use your fingers to separate the tibial n. from the loose connective tissue
3. The tibial n. passes deep to the plantaris & gastrocnemius m. at the inferior border of
the popliteal fossa

Lateral head of the

gastrocnemius m.

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Dissection CUT
1. At the inferior border of the popliteal fossa, insert your
index fingers between the two bellies of the
gastrocnemius m.
2. Pull the muscle bellies apart for a distance of 5 to 10 cm
3. This will expose the structures that pass from the
popliteal fossa into the leg

Lateral head of
gastrocnemius m.
Medial head of Medial sural
gastrocnemius m. cutaneous n.

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The branches of the popliteal a.
• The branches of the popliteal a. that participate in the formation of the arterial
anastomoses around the knee joint (genicular anastomosis)
• Superior lateral/medial genicular a.
• These a. are located deep in the popliteal fossa

Popliteal a.
Superior medial
genicular a. Superior lateral
genicular a.

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• Inferior lateral/medial genicular a.
• Popliteal a. passes deep to the plantaris & gastrocnemius m.
• Inferior genicular arteries pass deep to the superior attachments of the gastrocnemius m.

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Genicular a. CUT

TIPS
SMGA  Adductor magnus tendon
• Lateral counterpart  SLGA

IMGA Upper edge of the popliteus m.

• Lateral counterpart  ILGA

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 TIPS
Popliteal a. SMGA  Adductor magnus tendon Popliteal a.
• Lateral counterpart  SLGA

IMGA Upper edge of the popliteus m.

• Lateral counterpart  ILGA

SMGA SLGA SMGA

SLGA

ILGA
ILGA IMGA
IMGA
Tibia Fibula

Superior

Medial Lateral

Inferior
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Lower limb a.

Medial circumflex femoral a.

Inguinal ligament Deep Ascending
femoral a. Lateral circumflex femoral a. Transverse
External iliac a. Femoral a.
Descending
Superior lateral genicular a.
Genicular a. Inferior lateral genicular a.
Superior medial genicular a.
Interosseous Inferior medial genicular a.
Adductor Popliteal a. membrane
hiatus
Anterior tibial a.
Posterior tibial a.
Fibular a.

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Popliteus m.
• Inferior end of the popliteal a./v.  identify the popliteus m.
• It will be seen better when the posterior muscles of the leg are dissected

Popliteus m.
Origin Insertion Innervation
Lateral surface of the lateral condyle of Posterior surface of tibia
Tibial n.
femur 23
Pes anserinus
Sartorius, gracilis, semitendinosus tendons
• At the medial side of the knee, observe that the sartorius, gracilis, & semitendinosus tendons
• Converge on the proximal end of the tibia in an arrangement that is named the pes anserinus (L., goose’s foot)

Gracilis
muscle

Sartorius
muscle
Semitendinosus
tendons

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 Posterior compartment of the leg
• Lies posterior to the interosseous membrane, tibia, and fibula
• Transverse intermuscular septum divides the muscles of the posterior
compartment into superficial and deep groups

Posterior compartment of the leg

Group Superficial group Deep group

Muscle number 3 4
Popliteus m.
Gastrocnemius m.
Tibialis posterior m.
Muscle Soleus m.
Flexor digitorum longus m.
Plantaris m.
Flexor halluces longus m.
Plantar flexion of the foot
Function Plantar flexion of the foot Inversion of the foot
Flexion of the toes
Innervation Tibial n. Tibial n. 26
Posterior compartment of the leg
Superficial & deep groups

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 Gastrocnemius m.
• The most superficial muscle in the posterior compartment of the leg

Gastrocnemius m.
Superior attachment Inferior attachments Action
• Calcaneal tuberosity by way of the
On the femur just superior to the Plantar flexes the foot
calcaneal tendon
lateral and medial femoral condyles Flexes the leg
• Achilles tendon
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Gastrocnemius m. CUT

• Use scissors to transect the two heads

(medial & lateral) of the gastrocnemius
muscle at the point where they join Soleus m.

• Reflect the superior and inferior portions

of the muscle

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 Achilles Tendinopathy -A Runners Nightmare
Achilles tendon rupture appears to alter stiffness and length of the tendon
Clin Biomech (Bristol, Avon). 2022 Feb;92:105568.

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Soleus muscle
• Deep to the gastrocnemius muscle

Soleus m.
Superior attachment Inferior attachments Action
Soleal line of the tibia
• Calcaneal tendon (Achilles tendon) Plantar flexes the31 foot
The head of the fibula
Tendon of the plantaris m. & plantaris m.
• May be absent in a small percentage of cases
• The belly of the plantaris muscle lies in the popliteal fossa
• A thin muscle belly + a long thin tendon (30-45 cm)
• Innervation:
• Tibial n.

Plantaris m.
Superior attachment Inferior attachments Action
Lateral supracondylar line of Calcaneal tendon Plantar flexes the foot
the femur (Achilles tendon) Weak flexor of the leg
Plantaris tendon
Superior part Inferior part Note

Courses between the Medial side of the tendon of the • Joins the calcaneal tendon
gastrocnemius & soleus m. gastrocnemius m. • Attaches to the calcaneal tuberosity

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Tendon of the plantaris m. & plantaris m.

Plantaris m.

Soleus m.
Gastrocnemius m.

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Popliteus muscle (Deep)

Popliteus m.
Superior attachment Inferior attachments Action
• Rotates the femur on the tibia to
Posterior surface of the proximal
Lateral condyle of the femur unlock the extended knee
tibia
• A weak flexor of the leg 34
Tibial n. and posterior tibial vessels
• Tibial n. and posterior tibial vessels exit the popliteal fossa by passing deep to the
tendinous arch of the soleus muscle
• They course distally within the transverse intermuscular septum that separates the
superficial posterior muscle group from the deep posterior muscle group

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Dissection CUT
1. Use scissors to cut the soleus m. beginning at its tibial
(medial) attachment and extending across the leg to its
fibular attachment but leave the m. attached to the fibula
2. This cut should pass 2 cm inferior to the tendinous arch of
Plantaris m.
the soleus m.
3. Retract the soleus m. and the distal part of the
gastrocnemius m. laterally to expose the transverse
intermuscular septum
Soleus m.

• Identify the posterior tibial a. and v. and the tibial n. within Gastrocnemius m.
the transverse intermuscular septum
• The posterior tibial a. is usually accompanied by two v.
• Remove the veins to clear the dissection field

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• Use blunt dissection to follow the posterior tibial a. and the tibial n. proximally
• Observe that the popliteal a. bifurcates at the inferior border of the popliteus m. CUT
• Posterior tibial a.
• Anterior tibial a.

Popliteal a.
Tibial n.

Anterior tibial a.
Popliteus m.
Soleus m.

Flexor digitorum m.
Fibular a.
Posterior tibial a. Tibial n.

Tibialis posterior m.
Flexor hallucis m.

Lateral
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Tibialis posterior m.

Tibialis posterior m.
Superior attachment Inferior attachments Action
Tibia, fibula, & interosseous Plantar surfaces of several tarsal An inverter and plantar flexor of the
membrane bones foot 38
Flexor digitorum longus m.

Medial Lateral

Flexor digitorum longus m.

Superior attachment Inferior attachments Action
Bases of the distal phalanges of Flexes toes 2 to 5 and plantar flexes the
Tibia
the lateral four toes foot 39
Flexor hallucis longus m. (great toe)

Flexor digitorum
longus m.
Tibia
Tendon of tibialis Flexor hallucis longus m.
posterior m. Tendon of flexor
digitorum longus m.

Tendon of flexor
hallucis longus m.

Flexor hallucis longus m.

Superior attachment Inferior attachments Action
Inferior two-thirds of the fibula Base of the distal phalanx of the Flexes the great toe & plantar flexes
and interosseous membrane great toe the foot 40
 Popliteus m.

Flexor digitorum Tibialis

longus m. posterior m.
Flexor hallucis
Medial longus m.

Medial Lateral
Tendon of tibialis
posterior m.

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Flexor retinaculum
• Fibrous band of fascia
• From medial malleolus to the calcaneus
• In anterior to posterior order
• Tibialis posterior Flexor digitorum longus Posterior tibial a.  Tibial n.  Flexor hallucis longus

Medial
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Fibular a.
• Arises from the posterior tibial a. about 2 or 3 cm distal to the inferior border of the popliteus m.
• The fibular artery courses distally between
• Tibialis posterior m. & flexor hallucis longus m.
• Supplies
• Muscles of the lateral compartment of the leg
• Lateral side of the posterior compartment of the leg

Popliteus m.
Posterior tibial a.
Tibialis Fibular a.
posterior m. Flexor hallucis
longus m.

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• The perforating branch of the fibular a. usually arises just above the ankle joint
• Perforates the interosseous membrane and anastomoses with a branch of the anterior tibial a.

Interosseous
membrane
Fibula
Perforating branch Tibia
of fibular a.

Perforating branch
of fibular a.
Anterior view

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Skeleton of the Gluteal Region
• On the pelvis
• Gluteal line (posterior, anterior, inferior)
• Greater sciatic foramen
• Greater sciatic notch
• Ischia spine
• Lesser sciatic notch
• Lesser sciatic foramen
• Ischial tuberosity
• Sacrotuberous ligament
• Sacrospinous ligament
• On the femur
• Greater trochanter
• Intertrochanteric crest
• Trochanteric fossa
• Quadrate tubercle
• Gluteal tuberosity
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Skeleton of the Posterior Thigh
On the pelvis
• Ischial tuberosity

On the femur
• Lateral lip of linea aspera
• Lateral supracondylar line
• Medial condyle
• Lateral condyle
• Popliteal surface

On the fibula
• Head
• Neck

On the tibia
• Medial condyle
• Soleal line

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Thanks for your attention

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