‫”ﻗﺎﻟوا ﺳﺑﺣﺎﻧك ﻻ ﻋﻠم ﻟﻧﺎ إﻻ ﻣﺎ ﻋﻠﻣﺗﻧﺎ إﻧك أﻧت‬

‫اﻟﻌﻠﯾم اﻟﺣﻛﯾم“ ﺳورة اﻟﺑﻘرة آﯾﺔ )‪(32‬‬

 By:
Dr. Ayman Ahmed Khanfour
Professor of Anatomy & Embryology
Master degree in Obstetrics & Gynecology - MRCOG
Faculty of Medicine - Alexandria University
 What are the muscles of the post. compartment
of the thigh (Hamistring muscles)?

1. Semitendinosus
2. Semimmembranosus
3. Biceps femoris
 Origin:

1. Semimembranosus 2. Semitendinosus 3. Biceps femoris

- It arises by two heads:
Origin - Upper lateral part of - Lower medial part of a. Long head, arises from:
the upper area of the the upper area of the - Lower medial part of the
ischial tuberosity. ischial tuberosity. upper area of the ischial
(in common with long tuberosity.
head of biceps). b. Short head, arises from:
- Whole length of the linea
aspera and upper ½ of the
lateral supracondylar line
of the femur.
 Origin:

1. Semimembranosus 2. Semitendinosus 3. Biceps femoris

- It arises by two heads:
Origin - Upper lateral part of - Lower medial part of a. Long head, arises from:
the upper area of the the upper area of the - Lower medial part of the
ischial tuberosity. ischial tuberosity. upper area of the ischial
(in common with long tuberosity.
head of biceps). b. Short head, arises from:
- Whole length of the linea
aspera and upper ½ of the
lateral supracondylar line
of the femur.
 Insertions:

1. Semimembranosus 2. Semitendinosus 3. Biceps femoris

Insertion - Into a horizontal - Into the upper part of - Into the apex (styloid
groove on the back of the medial surface of process) of the head of
the medial condyle of the tibia. the fibula.
the tibia. (behind gracilis) (around the fibular
(thick and bulky (rounded tendon) collateral ligament)
tendon)
 Attachments & Actions:
 (Extension) (Flexion) (2 Simi. - Medial (2 Biceps – Lateral
rotation) rotation)

(Hip joint) (Knee joint) (Flexed knee joint)

(Actions of hamistring muscles & Animation “GIF”)

  Nerve supply:

 Semimembranosus + Semitendinosus + Long head of biceps femoris:

- Tibial component of sciatic nerve (L. 4, 5 - S. 1, 2, 3)
 Short head of biceps femoris:
- Common peroneal (fibular) part of sciatic nerve (L. 4, 5, S. 1, 2).
(Hamstring muscles)
(Sciatic nerve)
 Summary about the attachments and actions:
1. Semimembranosus 2. Semitendinosus 3. Biceps femoris
Origin - Upper lateral part of - Lower medial part of - It arises by two heads:
the upper area of the the upper area of the a. Long head, arises from:
ischial tuberosity. ischial tuberosity. - Lower medial part of the
(in common with long upper area of the ischial
head of biceps). tuberosity.
(in common with
semitendinosus).
b. Short head, arises from:
- Whole length of the linea
aspera and upper ½ of the
lateral supracondylar line
of the femur.
Insertion - Into a horizontal - Into the upper part of - Into the apex (styloid
groove on the back of the medial surface of process) of the head of
the medial condyle of the tibia. the fibula.
the tibia. (behind gracilis) (around the fibular
(thick and bulky tendon) (rounded tendon) collateral ligament)
Actions - The three muscles produce:
(all act on the a. Flexion of the knee joint.
hip and knee b. Extension of the hip joint.
- Semimembranosus + Semitendinosus produce: - Biceps produce:
joints)
* Medial rotation of the leg (on the flexed knee). * Lateral rotation of the leg
(on the flexed knee).
 Summary about the attachments and actions:
 Summary about the action of the muscles of the medial
compartment of the thigh: - Medial rotation
Biceps femoris Knee
2 Semi

Hip Semimembranosis - Flexion

- Extension Semitentenosis Biceps
Adductor magnus - Lateral rotation
(ischial part)
 Origin
Course (L. 4, 5 - S. 1, 2, 3) Branches
 It passers through A. Muscular:
great sciatic notch at 1. Tibial n.
the lower border of
a. Semimembranosus
piriformis.
b. Semitendinosus
c. Long head of biceps
 It descends in the d. Ischial part of add.
midline of the thigh.
magnus.
2. Common peroneal n.
In the middle of the
- Short head of biceps
thigh it divides into:
femoris.
a. Tibial n.
b. Common peroneal n. B. Articular:
- Hip joint
(Sciatic nerve)
(Sciatic nerve)
(Sciatic nerve)
 Surface Anatomy

- The sciatic nerve is represented by a line passing through the following points:
a. A point at the junction between the upper and middle thirds of a line between the
posterior superior iliac spine and the ischial tuberosity.
b. A point midway between the greater trochanter and the ischial tuberosity.
c. A point at the middle of the popliteal fossa.
 Summary about sciatic nerve:
L4,5 S 1, 2, 3

Sciatic n.
(Thigh)

Tibial n
(Popliteal
fossa) Post. tibial n.

(Leg)

Medial Lateral Medial Lateral Medial Lateral

(Foot)
plantar plantar terminal terminal terminal terminal
nerve nerve branch branch branch branch
 Applied Anatomy
I. Gluteal intermuscular injection

 Site: In the upper lateral quadrant of the gluteal region.

 Cause: To avoid injury to the sciatic nerve.
II. Injury of the sciatic nerve:
A. Motor loss:
- Paralyses of the hamstring
muscles (weakness on flexion of
the knee because sartorius and
gracilis can produce some
flexion).
- Complete paralysis of all muscles
of the leg and foot leading to
“flail foot” (‫ )ﻣﺛل ﺑﻧدول اﻟﺳﺎﻋﺔ‬which
is accompanied by “foot drop”
due to the effect of gravity.
B. Sensory loss
- Loss of sensation (anesthesia) on
the leg and foot EXCEPT the area
supplied by saphenous nerve
which is the medial side of leg and
foot till the base of big toe.
 Definition

 It is a diamond shaped intermuscular space behind the

knee joint.
 Boundaries

a. Upper lateral border: Biceps femoris.

b. Upper medial border: Sartorius, gracilis, semitendinosus, +
semimembranosus.
c. Lower lateral border: Lateral head of gastrocnemius + Plantaris.
d. Lower medial border: Medial head of gastrocnemius.
(Popliteal fossa - Boundaries)
 Roof

a. Skin
b. Superficial fascia
- It contains upper part of the short saphenous vein and lower part of posterior
cutaneous nerve of the thigh.
c. Deep fascia (popliteal fascia)
- It is pierced by small saphenous vein and posterior cutaneous nerve of thigh.
(Popliteal fossa - Roof)
 Floor

 It is formed by the following: 

a. Upper third ----------------- Popliteal surface of the femur.
b. Middle third ---------------- Capsule of the knee joint.
c. Lower third ----------------- Popliteus muscle covered by its fascia.
 Contents
1. Popliteal artery

2. Popliteal vein

3. Tibial nerve

4. Common
peroneal nerve

5. Popliteal
lymph nodes

6. Popliteal fat
 Common Peroneal Nerve
Branches
Origin
A. Muscular:
 It is one of the two
- No in the popliteal
terminal branches
fossa.
of the sciatic nerve
L. 4, 5 - S. 1, 2, - As a part of sciatic
nerve, it gives muscular
branch to the short head
of biceps (before
reaching the fossa).

B. Cutaneous:
1. Sural communicating n.
2. Lateral cutaneous n. of
the calf.

C. Articular:
1. Sup. lat. genicular n.
2. Inf. lat. genicular n.
(Common peroneal nerve)
 Injury of Common Peroneal Nerve
 Cause: Fracture of the neck of fibula.

 Results:
1. Foot drop due to paralysis of the doriflexors of the leg.
2. Loss of cutaneous sensation on the lower part of the front of the leg,
intermediate part of the dorsum of the foot, and dorsum of all toes EXCEPT
the lateral side of the little toe (supplied by the sural nerve).
 Tibial Nerve
Origin Branches
A. Muscular:
 It is one of the two
- Plantaris
terminal branches
of the sciatic nerve - Gastrocnemius
L. 4, 5 - S. 1, 2, 3. - Soleus
- Popliteus
B. Cutaneous:
1. Sural nerve
- It supplies the lateral
side of the leg.

C. Articular:
1. Sup. med. genicular n.
2. Inf. Med. genicular n.
3. Middle genicular n.
 Injury of the Tibial Nerve
 Cause: Traumatic injury.

 Results:
1. Paralysis of the muscles of the posterior compartment of the leg
- This paralysis leads to weakness of planter flexion (as some planter flexion can
be done by peronei longus and brevis).
- Weakness of inversion of the foot (as some inversion can be done by tibialis
anterior).
2. Paralysis of the intrinsic muscles of the foot leading to atrophy of these
muscles.
3. Loss of cutaneous sensation over the back of the leg, lateral border of the foot,
and lateral side of the little toe.
4. Loss of cutaneous sensation over the sole of the foot, plantar aspect of all digits
which are supplied by the medial and lateral plantar nerves.
 It is the DEEPEST structure in the popliteal fossa.
 Applied anatomy:

- Fracture of the lower part of the shaft of the femur commonly

accompanied by injury of the popliteal artery (due to its close
contact to the bone).
Question 1

Muscles in the posterior thigh compartment

are paralyzed because the sciatic nerve has
been severed. On examination, the patient can
still produce some flexion of the leg. Explain
on anatomical bases?
Question 2

What is the arterial supply of sciatic nerve

and its origin. Give its clinical importance?
Question 3

A 22 years old man was subjected to car accident. On

examination, the patient was shocked with large
swelling on the back of his knee joint. X-ray revealed
fracture of the lower end of the femur. What is your
explanation to the shock and the swelling of his knee
joint?
For Contact:
Dr. Ayman Ahmed Khanfour

[email protected]

Dr. Ayman Khanfour

Dr-Ayman Ahmed Khanfour

Dr. Ayman Anatomy Discussion