POSTERIOR COMPARTENT OF THE

THIGH AND THE POPLITEAL FOSSA

By
CHUKWU, V.O
 INTRODUCTION
• The muscles in the posterior
compartment of the thigh are
collectively known as
the hamstrings.

They consist of:

• The biceps femoris,
• Semitendinosus and
• Semimembranosus, which form
prominent tendons medially and
laterally at the back of the knee.
 INTRODUCTION
• These muscles are a group of three long
muscles located in the posterior compartment
of the thigh, shaping up the surface anatomy of
this region.

• The hamstrings are closely related to each other

as they share a common origin point, and they
all attach to the proximal parts of
the tibia and fibula. They are innervated by
the tibial and common fibular (peroneal)
divisions of the sciatic nerve (L4-S3).

• All the hamstring muscles cross

the hip and knee joints and act upon them.

• The primary function of the hamstrings is to flex

the knee joint and extend the hip, enabling
some of the essential lower limb activities such
 INTRODUCTION
• The hamstrings have an
important stabilizing function as well; they
are inactive when the bodyweight is equally
distributed between both lower limbs in a
standing position.

• However, when a person starts tilting

forward, these muscles activate and
counteract the tilting movement in order to
stabilize the hip joint and prevent falling.

• Also, due to the location of their insertions,

the hamstrings act together with the
collateral ligaments to stabilize the knee
joint.
 BICEPS FEMORIS
• The biceps femoris has two heads (long
head and short head) and is the most
lateral of the muscles in the posterior
thigh.

• The common tendon of the two heads can

be felt laterally within the popliteal fossa
(posterior knee region).

• Attachments: The long head originates

from the ischial tuberosity of the pelvis.

• The short head originates from the linea

aspera on posterior surface of the femur.

• Together, the heads form a tendon, which

inserts into the head of the fibula and
lateral condyle of the tibia.
 BICEPS FEMORIS

Actions: Main action is flexion

at the knee.

• It also extends the thigh at

the hip and laterally rotates
the hip and knee.

• Innervation: Long head is

innervated by the tibial part
of the sciatic nerve.
• The short head is innervated
by the common fibular part
of the sciatic nerve. (L5, S1)
 SEMITENDINOSUS
• The semitendinosus is a largely
tendinous muscle.
• It is situated on the medial aspect
of the posterior thigh and
superficial to the
semimembranosus.

• Attachments: It originates from

the superior medial quadrant and
posterior surface of the ischial
tuberosity.
• It inserts on the superior aspect
and medial tibial shaft.
 SEMITENDINOSUS
• Actions: Flexion of the leg at
the knee joint. Extension of
thigh at the hip.

• Medially rotates the thigh at

the hip joint and the leg at
the knee joint.

• Innervation: Tibial part of

the sciatic nerve. (L5,S1).
 SEMIMEMBRANOSUS
• The semimembranosus muscle is
flattened and broad.

• It is located deep to the

semitendinosus on the medial
aspect of the posterior thigh.

• Attachments: It originates from

superior lateral quadrant of
posterior surface ischial
tuberosity (more superiorly than
the origin of the semitendinosus
and biceps femoris).

• Attaches to the medial tibial

condyle.
 SEMIMEMBRANOSUS

• Actions: Flexion of the leg at

the knee joint. Extension of
thigh at the hip.

• Medially rotates the thigh at

the hip joint and the leg at
the knee joint.

• Innervation: Tibial part of the

sciatic nerve (L5, S1).
TRANVERSE SECTION OF THE THIGH
 BLOOD SUPPLY, VENOUS AND LYMPHATIC
DRAINAGE
• The hamstring muscles receive vascular supply from the perforating branches
of the deep femoral artery, also known as the profunda femoris artery.

• The demarcation between the external iliac artery and the femoral artery is
the inguinal ligament.

• In general, the deep veins of the thigh share the same name as the major
arteries they follow. The femoral vein is responsible for significant venous
drainage of the thigh.

• It accompanies the femoral artery and receives additional venous drainage

from the profunda femoris vein. Like the femoral artery, the femoral vein
transitions to the external iliac vein at the level of the inguinal ligament.

• The lymphatic drainage of the thigh also mirrors the arterial supply and
eventually drains into the lumbar lymphatic trunks and cisterna chyli.
 NERVE SUPPLY
• The hamstring muscle complex is innervated by nerves
that arise from the lumbar and sacral plexuses.

• These plexuses give rise to the sciatic nerve (L4-S3), which

bifurcates into the tibial and common peroneal (fibular)
nerves at the level of the tibiofemoral joint.

• The tibial nerve innervates the semimembranosus,

semitendinosus, and long head of the biceps femoris
muscles.

• The common peroneal branch of the sciatic nerve

innervates the short head of the biceps femoris.
 CLINICAL ANATOMY
Hamstring Muscle Injury
• Hamstring injury can occur if any of the
tendons or muscles are stretched beyond
their limit.
• They often occur during sudden, explosive
movements, such as sprinting, lunging or
jumping. But they can also occur more
gradually, or during slower movements that
overstretch your hamstring.

• Recurring injury is common in athletes and

sportsmen, as one more likely to injure
their hamstring if they have been injured
before.

• Regularly doing stretching and

strengthening exercises, and warming up
before exercise, may help reduce the risk of
 HAMSTRING AVULSION FRACTURE OF THE ISCHIAL TUBEROSITY
• An avulsion fracture occurs when a fragment of
bone attached to a ligament or tendon gets pulled
away from the main mass of the bone.

• The muscles of the posterior thigh all originate from

the ischial tuberosity of the pelvis.

• In rare cases (predominantly adolescents), sudden

and forceful contraction of the hamstrings can
result in an avulsion fracture of the ischial
tuberosity.

• Patients with this injury often experience a sudden

pain in the posterior thigh, followed by an inability
to walk. It can be associated with sciatic
nerve damage (the nerve lies in close location and
could be compressed by a displaced fragment of
HAMSTRING AVULSION FRACTURE OF THE ISCHIAL TUBEROSITY

• Treatment of avulsion fractures of the ischial

tuberosity can be conservative or surgical:

• Conservative: Rest, pain control and

physiotherapy.

• Surgical: Open reduction and internal fixation

(setting the fracture in the correct position and
then fixing in place with metalwork).
 PHYSIOLOGIC VARIANTS
• Although uncommon, surgeons must remain aware of hamstring
muscle anatomical variations.

• The hamstring muscle group, except for the short head of the
biceps femoris, typically originates from a conjoint muscle tendon
arising from the ischial tuberosity.

• Interestingly, there are reports which reveal variants where the

semitendinosus and the long head of the biceps femoris appear
from distinct tendinous origins.

• A report revealed findings of a third head of the biceps femoris

and an anomalous muscle inserted into the semimembranosus.

• There is also a report of a patient with a bilateral absence of the

semimembranosus muscles.
 POPLITEAL FOSSA
• The popliteal
fossa is a diamond
shaped area
located on the
posterior aspect of
the knee.

• It is the main path

by which vessels
and nerves pass
between the thigh
and the leg.
 BOUNDARIES OF THE POPLITEAL FOSSA
Superficially, the popliteal fossa is bounded:
• Superolaterally by the biceps femoris
(superolateral border).

• Superomedially by the semimembranosus,

lateral to which is the semitendinosus
(superomedial border).

• Inferolaterally and inferomedially by the

lateral and medial heads of the
gastrocnemius, respectively (inferolateral
and inferomedial borders).

• Posteriorly by skin and popliteal fascia

(roof).
 BOUNDARIES OF THE POPLITEAL FOSSA
• The floor of the
popliteal fossa is
formed by the
 posterior surface of the
knee joint capsule,
 popliteus muscle and
 posterior femur.

• The roof is made of up

two layers: popliteal
fascia and skin.

• The popliteal fascia is

continuous with
the fascia lata of the
 CONTENTS OF THE POPLITEAL FOSSA
The popliteal fossa is the main conduit
for neurovascular structures
entering and leaving the leg.
Its contents are:
• Termination of small sephanous
vein
• Popliteal artery and their branches
• Popliteal vein and their tributaries
• Tibial nerve
• Common fibular nerve (common
peroneal nerve)
• Posterior cutaneous nerve of thigh
• Popliteal lymph nodes and
lymphatic vessels
 CONTENTS OF THE POPLITEAL FOSSA
• The tibial and common fibular nerves are the
most superficial of the contents of the
popliteal fossa.

• They are both branches of the sciatic nerve.

The common fibular nerve follows the biceps
femoris tendon, travelling along the lateral
margin of the popliteal fossa.

• The small saphenous vein pierces the popliteal

fascia and passes between the two heads of
gastrocnemius to empty into the popliteal vein.

• In the popliteal fossa, the deepest structure is

the popliteal artery.

• It is a continuation of the femoral artery, and

travels into the leg to supply it with blood.
 NEUROVASCULAR STRUCTURES AND
RELATIONSHIPS IN POPLITEAL FOSSA
• All important neurovascular structures that pass
from the thigh to the leg do so by traversing the
popliteal fossa.

• Progressing from superficial to deep (posterior to

anterior) within the fossa, as in dissection, the
nerves are encountered first, then the veins.

• The arteries lie deepest, directly on the surface

of the femur, joint capsule, and investing fascia
of the popliteus forming the floor of the fossa.
 CLINICALS

Swelling in the Popliteal Fossa

• The appearance of a mass in the popliteal
fossa has many differential diagnoses.

• The two main causes are baker’s cyst and

aneurysm of the popliteal artery.
 BAKER’S CYST
• A Baker’s cyst (popliteal cyst)
refers to the inflammation and
swelling of
the semimembranosus bursa – a
sac-like structure containing a
small amount of synovial fluid.

• It usually arises in conjunction

with osteoarthritis of the knee.

• Whilst it usually self-resolves, the

cyst can rupture and produce
symptoms similar to deep vein
thrombosis.
 ANEURYSM OF THE POPLITEAL ARTERY
• An aneurysm is a dilation of an artery, which is
greater than 50% of the normal diameter.

• The popliteal fascia (the roof of the popliteal

fossa) is tough and non-extensible, and so an
aneurysm of the popliteal artery has
consequences for the other contents of the
popliteal fossa.

• The tibial nerve is particularly susceptible to

compression from the popliteal artery. The
major features of tibial nerve compression are:

• Weakened or absent plantar flexion

• Paraesthesia of the foot and posterolateral leg

An aneurysm of the popliteal artery can be

 POPLITEAL PULSE
• Because the popliteal artery is deep, it
may be difficult to feel the popliteal
pulse.

• Palpation of this pulse is commonly

performed with the person in the prone
position with the knee flexed to relax
the popliteal fascia and hamstrings.

• The pulsations are best felt in the

inferior part of the fossa where the
popliteal artery is related to the tibia.

• Weakening or loss of the popliteal pulse

is a sign of a femoral artery obstruction.
 G
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