POPLITEAL FOSSA Popliteal Fossa Bony landmarks: Bony landmarks: Popliteal surface of femur (floor)....

POPLITEAL FOSSAPOPLITEAL FOSSA

Popliteal FossaPopliteal Fossa

Bony landmarks:Bony landmarks:Popliteal surface of femur (floor).Popliteal surface of femur (floor).

Boundaries:Boundaries:Superior:Superior:

Semimembranosus and semitendinosus.Semimembranosus and semitendinosus.Inferior:Inferior:

Medial and lateral heads of the Medial and lateral heads of the gastrocnemius.gastrocnemius.


Contents:Contents:Fat.Fat.Several popliteal lymph nodes.Several popliteal lymph nodes.Popliteal bursa.Popliteal bursa.Superficial to deep:Superficial to deep:

Tibial nerve.Tibial nerve.Popliteal vein.Popliteal vein.Popliteal artery.Popliteal artery.

Common peroneal (fibular) nerve.Common peroneal (fibular) nerve.Small saphenous vein.Small saphenous vein.


Contents:Contents:Popliteal artery:Popliteal artery:

Continuation of femoral artery.Continuation of femoral artery.

Begins at adductor hiatus.Begins at adductor hiatus.

Ends at lower border of popliteus Ends at lower border of popliteus muscle.muscle.

Divides into anterior and posterior tibial Divides into anterior and posterior tibial arteries.arteries.


Contents:Contents:Popliteal vein:Popliteal vein:

Formed from venae comitantes of anterior Formed from venae comitantes of anterior and posterior tibial arteries.and posterior tibial arteries.

Receives lesser saphenous vein.Receives lesser saphenous vein.

Becomes femoral vein at adductor hiatus.Becomes femoral vein at adductor hiatus.


Contents:Contents:Tibial nerve:Tibial nerve:

Part of sciatic nerve.Part of sciatic nerve.

Supplies posterior thigh and leg.Supplies posterior thigh and leg.

Common peroneal nerve:Common peroneal nerve:

Part of sciatic nerve.Part of sciatic nerve.

Branches into superficial and deep Branches into superficial and deep peroneal peroneal (fibular) nerves:(fibular) nerves:

Supplies lateral and anterior leg.Supplies lateral and anterior leg.


Sural nerve:Sural nerve:Arises via:Arises via:

Communicating branch from tibial nerve.Communicating branch from tibial nerve.

Communicating branch from common Communicating branch from common peroneal (fibular) nerve.peroneal (fibular) nerve.


Genicular anastomosis:Genicular anastomosis:

Descending genicular:Descending genicular:from femoral.from femoral.

Descending branch of lateral femoral Descending branch of lateral femoral circumflex.circumflex.

Genicular branches of popliteal artery:Genicular branches of popliteal artery:

Medial superior/inferior genicular.Medial superior/inferior genicular.

Lateral superior/inferior genicular.Lateral superior/inferior genicular.

Middle genicular.Middle genicular.


Genicular anastomosis:Genicular anastomosis:Branches of anterior tibial:Branches of anterior tibial:

Circumflex fibular.Circumflex fibular.

Anterior tibial recurrent.Anterior tibial recurrent.

Branches of posterior tibial:Branches of posterior tibial:Posterior tibial recurrent.Posterior tibial recurrent.

LEGLEG

Bones of the LegBones of the Leg

Tibia:Tibia:Most common long bone to be fractured.Most common long bone to be fractured.Relatively poor blood supply.Relatively poor blood supply.Anteromedial surface is “bare.”Anteromedial surface is “bare.”

Available for bone grafts.Available for bone grafts.

Soleal (oblique) line on posterior surface.Soleal (oblique) line on posterior surface.Fibula:Fibula:

Lateral malleolus important in ankle Lateral malleolus important in ankle stability.stability.

Site for muscle attachment.Site for muscle attachment.

Crural FasciaCrural Fascia

Continuous with fascia latae.Continuous with fascia latae.Attachment to anterior and medial borders Attachment to anterior and medial borders

of of tibia:tibia:Continuous with periosteum.Continuous with periosteum.Leaves bare area.Leaves bare area.

Fascia forms retinacula in foot:Fascia forms retinacula in foot:Superior (extensor) retinaculum:Superior (extensor) retinaculum:

Proximal to malleoli.Proximal to malleoli.Binds tendons in anterior crural Binds tendons in anterior crural

compartment.compartment.

Crural FasciaCrural Fascia

Fascia forms retinacula in foot:Fascia forms retinacula in foot:Inferior (extensor) retinaculum:Inferior (extensor) retinaculum:

““Y”-shaped.Y”-shaped.

Flexor retinaculum:Flexor retinaculum:

Binds tendons of the deep posterior Binds tendons of the deep posterior compartment.compartment.

Superior/inferior peroneal retinacula:Superior/inferior peroneal retinacula:

Bind tendons of lateral crural compartment.Bind tendons of lateral crural compartment.

Superficial Posterior Superficial Posterior CompartmentCompartment

Cutaneous nerves:Cutaneous nerves:Lateral sural cutaneous nerve:Lateral sural cutaneous nerve:

From common peroneal.From common peroneal.

Medial sural cutaneous:Medial sural cutaneous:From tibia.From tibia.

Sural nerve runs with lesser Sural nerve runs with lesser saphenous saphenous vein.vein.


Muscles:Muscles:Gastrocnemius:Gastrocnemius:

Crosses both knee and ankle joint.Crosses both knee and ankle joint.

Two heads form inferior boundaries of the Two heads form inferior boundaries of the popliteal fossa.popliteal fossa.

Lateral head may have a sesamoid bone:Lateral head may have a sesamoid bone:

Fabella.Fabella.

Plan:Plan:plantarisplantaris

MG:MG:med. Gastroc.med. Gastroc.

LG:LG:lat. Gastroc.lat. Gastroc.

Sol:Sol:soleussoleus

TC:TC:tendo tendo calcaneuscalcaneus


Muscles:Muscles:Plantaris:Plantaris:

May be absent.May be absent.

Tendon may be used for hand surgery.Tendon may be used for hand surgery.


Muscles:Muscles:Soleus:Soleus:

Broad multipennate muscle.Broad multipennate muscle.

Unijoint muscle.Unijoint muscle.

Triceps surae:Triceps surae:= soleus + two heads of gastrocnemius.= soleus + two heads of gastrocnemius.

Common insertion:Common insertion:Calcaneus via Achilles tendon (tendo Calcaneus via Achilles tendon (tendo calcaneus)calcaneus)

Plan:Plan:

plantarisplantaris

Sol:Sol:

soleussoleus


Nerve supply:Nerve supply:Tibial nerve:Tibial nerve:

Supplies all muscles in posterior Supplies all muscles in posterior compartment.compartment.Divides into medial and lateral plantar Divides into medial and lateral plantar

nerves nerves inferior and posterior to medial malleolus.inferior and posterior to medial malleolus.Gives off medial sural cutaneous nerve.Gives off medial sural cutaneous nerve.Joins with communicating branch of Joins with communicating branch of

common common peroneal (fibular) nerve to form:peroneal (fibular) nerve to form:Sural nerve:Sural nerve:Cutaneous.Cutaneous.


Blood supply:Blood supply:Posterior tibial artery:Posterior tibial artery:

Largest branch of popliteal artery.Largest branch of popliteal artery.Divides into medial and lateral plantar Divides into medial and lateral plantar

arteries arteries deep to origin of abductor hallucis deep to origin of abductor hallucis muscle.muscle.

Peroneal artery:Peroneal artery:Most important branch of posterior tibial Most important branch of posterior tibial artery.artery.Supplies lateral compartment and popliteus Supplies lateral compartment and popliteus muscles.muscles.Supplies other muscles in posterior Supplies other muscles in posterior compartment.compartment.

Deep Posterior CompartmentDeep Posterior Compartment

Muscles:Muscles:Popliteus:Popliteus:

Lies in floor of popliteal fossa.Lies in floor of popliteal fossa.

Flexes and rotates knee.Flexes and rotates knee.

Flexor digitorum longus:Flexor digitorum longus:Tendon passes posterior to medial Tendon passes posterior to medial

malleolus malleolus and to tendon of tibialis posterior.and to tendon of tibialis posterior.

Plantarflexes foot at ankle joint.Plantarflexes foot at ankle joint.


Muscles:Muscles:Flexor hallucis longus:Flexor hallucis longus:

Tendon occupies groove on posterior Tendon occupies groove on posterior surface surface of talus:of talus:

Continuous with groove on plantar Continuous with groove on plantar surface of sustentaculum tali.surface of sustentaculum tali.

Tendon passes posterior to medial Tendon passes posterior to medial malleolus.malleolus.

Tendon passes between two sesamoid Tendon passes between two sesamoid bones.bones.Push-off muscle for walking, jumping, Push-off muscle for walking, jumping, running.running.


Muscles:Muscles:Tibialis posterior:Tibialis posterior:

Functions in plantarflexion and foot Functions in plantarflexion and foot inversion.inversion.

Helps to maintain medial longitudinal arch.Helps to maintain medial longitudinal arch.

Pop:Pop:

popliteuspopliteus

TP:TP:

tibialis post.tibialis post.

PL:PL:

peroneus longusperoneus longus

FD:FD:

flex. dig. long.flex. dig. long.

PB:PB:

peroneus brevisperoneus brevis

FHL:FHL:

flex. hall. long.flex. hall. long.


Nerve supply:Nerve supply:Tibialis nerve:Tibialis nerve:

Blood supply:Blood supply:Posterior tibial artery.Posterior tibial artery.

Anterior CompartmentAnterior Compartment

Muscles:Muscles:Tibialis anterior:Tibialis anterior:

Lateral to crest of tibia.Lateral to crest of tibia.

Foot dorsiflexion and inversion.Foot dorsiflexion and inversion.

L4-L5.L4-L5.

Paralysis results in foot drop.Paralysis results in foot drop.


Muscles:Muscles:

Extensor digitorum longus:Extensor digitorum longus:

Four tendons of insertion:Four tendons of insertion:

Each tendon inserts on an Each tendon inserts on an extensor extensor expansion .expansion .

Similar to arrangement in hand.Similar to arrangement in hand.

Extends toes at MTP and dorsiflexion.Extends toes at MTP and dorsiflexion.


Muscles:Muscles:Peroneus (fibularis) tertius:Peroneus (fibularis) tertius:

Part of extensor digitorum longus.Part of extensor digitorum longus.

Sometimes missing.Sometimes missing.

Functions in foot dorsiflexion and Functions in foot dorsiflexion and eversion.eversion.

Extensor hallucis longus.Extensor hallucis longus.

TA:TA:tibialis anteriortibialis anterior

EDL:EDL:extensor digitorum extensor digitorum longuslongus

EHL:EHL:extensor hallucis extensor hallucis longuslongus

PT:PT:peroneus tertiusperoneus tertius

IM:IM:

interosseous interosseous membranemembrane

ED:ED:

extensor extensor digitorum longusdigitorum longus

EHL:EHL:

extensor hallucis extensor hallucis longuslongus

PT:PT:

peroneus tertiusperoneus tertius


Function:Function:

Toe extension.Toe extension.

Ankle dorsiflexion.Ankle dorsiflexion.


Innervation:Innervation:Deep peroneal (fibular) nerve.Deep peroneal (fibular) nerve.

L4-5 to tibialis anterior.L4-5 to tibialis anterior.

L5-S1 for remaining muscles.L5-S1 for remaining muscles.

Runs deep to extensor digitorum longus.Runs deep to extensor digitorum longus.

Accompanies anterior tibial artery between Accompanies anterior tibial artery between extensor hallucis longus and tibialis extensor hallucis longus and tibialis

anterior anterior muscles.muscles.


Blood supply:Blood supply:Anterior tibial artery:Anterior tibial artery:

Smaller of terminal branches of popliteal Smaller of terminal branches of popliteal artery.artery.

Begins at inferior border of popliteus Begins at inferior border of popliteus muscle.muscle.

Becomes dorsalis pedis artery at ankle Becomes dorsalis pedis artery at ankle joint.joint.

Lateral CompartmentLateral Compartment

Muscles:Muscles:

Peroneus (fibularis) longus:Peroneus (fibularis) longus:More superficial of the two.More superficial of the two.

Easily palpated.Easily palpated.

Its tendon uses lateral malleolus as a Its tendon uses lateral malleolus as a pulley.pulley.

Tendon crosses sole of foot and inserts on Tendon crosses sole of foot and inserts on first metatarsus and cuneiform.first metatarsus and cuneiform.

Helps to maintain transverse and Helps to maintain transverse and longitudinal longitudinal arches of the foot.arches of the foot.


Muscles:Muscles:Peroneus (fibularis) brevis:Peroneus (fibularis) brevis:

Deep to peroneus longus.Deep to peroneus longus.

Inserts on lateral tuberosity.Inserts on lateral tuberosity.

Function:Function:Plantar flexion.Plantar flexion.

Foot eversion.Foot eversion.


Nerve supply:Nerve supply:Superficial peroneal (fibular) nerve:Superficial peroneal (fibular) nerve:

Deep to peroneus longus.Deep to peroneus longus.Inserts on lateral tuberosity.Inserts on lateral tuberosity.

Blood supply:Blood supply:No major arteries in lateral compartment.No major arteries in lateral compartment.

Muscular branches arise from the peroneal Muscular branches arise from the peroneal artery:artery:

Branch of posterior tibial.Branch of posterior tibial.


Spinal cord levels:Spinal cord levels:L5, S1-2L5, S1-2

POPLITEAL FOSSA Popliteal Fossa Bony landmarks: Bony landmarks: Popliteal surface of femur (floor)....

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Transcript of POPLITEAL FOSSA Popliteal Fossa Bony landmarks: Bony landmarks: Popliteal surface of femur (floor)....