Thigh and Popliteal Fossa - A Partial Study Guide

Hamstrings

• Biceps femoris
  • long head - tibial, biarticulate, hamstring
  • short head - peroneal, NOT biarticulate, NOT hamstring
• Semitendinosus
• Semimembranosus
• Definition of hamstring
  1. ischial tuberosity
  2. insert on leg
  3. tibial nerve

Quadraceps

1. Rectus femoris
2. Vastus medialis
3. Vastus intermedius
4. Vastus lateralis

Pes anserinus and cross section of the thigh

1. Sartorius - femoral n.
2. Gracilis - obturator n.
3. Semitendinosus - tibial sciatic

Popliteal fossa

• Borders - diamond shaped, remember anterior and posterior
  • superior lateral:
  • superior medial:
  • inferior lateral:
  • inferior medial:
  • superior: description
  • inferior: description
  • anterior:
  • posterior:
• Contents
  • superficial to deep - sciatic, tibial, common peroneal nerves, popliteal vein, popliteal artery
• Genicular anastomosis
  1. superior medial genicular a. - immedately superior to femoral condyle and origin of gastrocnemius
  2. superior lateral genicular a. - immedately superior to femoral condyle and origin of gastrocnemius
  3. descending genicular a.
  4. descending branch of lateral femoral circumflex a.
  5. inferior medial genicular a.
  6. inferior lateral genicular a.
  7. posterior tibial recurrent a.
  8. anterior tibial recurrent a.
  9. fibular circumflex a.
  10. middle genicular a.

Questions for the Thigh and Popliteal Fossa

True/False - August 10, 2011

1. Despite a total lesion of the tibial portion of the sciatic nerve, flexion of the knee remains possible.
2. Despite a total lesion of the sciatic nerve; flexion of the knee remains possible.
3. Despite total lesions of the sciatic nerve and the femoral nerve; flexion of the knee remains possible.
4. Despite total lesions of the sciatic nerve, femoral nerve, and obturator nerve; flexion of the knee remains possible.
5. The first perforating artery supplies, in part, the upper part of the posterior thigh.
6. The popliteal artery supplies, in part, the lower region of the posterior thigh.
7. The inferior gluteal artery supples the sciatic nerve.
8. The perforating arteries supply the sciatic nerve.
9. The popliteal artery supplies the sciatic nerve.
10. The posterior surface of the distal femur contributes to the anterior boundary of the popliteal fossa.
11. The superior medial genicular artery circles the femur at a location superior to the adductor tubercle and deep the tendon of the posterior adductor magnus.
12. The inferior lateral genicular artery crosses the anterior surface of the popliteus muscle.
13. The oblique popliteal ligament, derived from the tendon of insertion of the semimembranosus, crosses the posterior knee capsule from inferior lateral to superior medial.
14. The fibular circumflex artery crosses the medial surface of the neck of the fibular and the anterior tibial artery crosses the lateral surface of the neck of the fibula.
15. The middle genicular artery enters the intercondyler fossa from the posterior joint capsule of the knee.
16. The pes anserinus can be linked to 3 motor nerves, three compartments of the thigh, and one sensory nerve.
17. Lymph from the dorsal lateral region of the foot drains, in part, to the popliteal lymph nodes.

True/False - August 11, 2010

1. The short head of the biceps femoris is innervated by the common peroneal part of the sciatic nerve.
2. The posterior part of the adductor magnus arises from the ischial tuberosity, inserts on the adductor tubercle, and is innervated by the obturator nerve.
3. The semitendinosus has a long tendon of origin.
4. The semitendinosus provides a membranous tendon of insertion.
5. The short head of the biceps femoris, unlike the hamstring muscles, can flex the knee despite that the hip is fully extended.
6. The sciatic nerve at the mid-thigh is posterior to the hamstrings.
7. Only one nerve arises from lateral side of the sciatic nerve and this nerve innervates the long head of biceps femoris.
8. The short head of the biceps femoris flexes the knee, laterally rotates the knee, and extends the hip.
9. The femoral vein, within the adductor canal, is deep to the femoral artery and the popliteal vein, within the popliteal fossa, is superficial to the popliteal artery.
10. The femoral vein, within the adductor canal, is posterior to the femoral artery and the popliteal vein, within the popliteal fossa, is posterior to the popliteal artery.
11. The transverse branch of the lateral femoral circumflex artery contributes to the genicular anastomosis.
12. The superior medial genicular artery passes through the adductor hiatus.
13. The superior medial genicular artery passes deep to the tendon of insertion from the posterior adductor magnus.
14. The descending genicular artery passes through the adductor hiatus.
15. The inferior lateral genicular artery crosses the posterior surface of the popliteus muscle.
16. The peroneal communicating branch of the lateral cutaneous sural nerve converges onto the medial sural cutaneous nerve to from sural nerve.
17. Despite total destruction of the sciatic nerve, flexing the knee is still possible.
18. Despite total destruction of the femoral nerve, flexing the knee is still possible.
19. Despite total destruction of the obturator nerve, flexing the knee is still possible.
20. Despite total destruction of the sciatic and femoral nerves, flexing the knee is still possible.
21. Despite total destruction of the obturator and femoral nerves, flexing the knee is still possible.
22. Despite total destruction of the obturator and sciatic nerves, flexing the knee is still possible.
23. Despite total destruction of the obturator, sciatic, and femoral nerves, flexing the knee is still possible.
24. Each of the three muscles that insert at the pes anserinus have a different innervation.

Definitions and Short Answer

1. Pes anserinus
2. The tibial portion of the sciatic nerve is lesioned. Is flexion at the knee possible? If so, by what muscles?
3. The tibial and peroneal portion of the sciatic nerve is lesioned. Is flexion at the knee possible? If so, by what muscles?
4. The sciatic nerve and the obturator nerve are entirely lesioned. Is flexion at the knee possible? If so, by what muscles?
5. The sciatic nerve, obturator nerve, and femoral nerve are entirely lesioned. Is flexion at the knee possible? If so, by what muscles?
6. Why is the short head of the biceps not a hamstring. Why is the posterior adductor magnus not a hamstring? Why is tensor fascia lata not a hamstring?
7. What is the relationship of the superior medial genicular artery to the tendon of insertion of the posterior adductor magnus?
8. What is the relationship of the inferior lateral genicular artery to the popliteus muscle?
9. Thus far, we have discussed the cruciate anastomosis and the genicular anastomosis. Take note that these anastomoses occur in regions of high mobility. What may be the advantage for these anastomotic arterial networks?
10. From anterior/lateral to posterior/medial the insertions of the pes anserinus are the (blank), (blank), and (blank) muscles. The muscles are, in the above order, located in the (blank), (blank), and (blank) compartments of the (blank). In order, they are innervated by the (blank), (blank), and (blank) nerves. In order, the primary actions at the hip joint are (blank), (blank), and (blank). In order, the primary actions at the knee joint are (blank), (blank), and (blank). This anatomy has been referred to as an inverted (blank).
11. The inferior lateral genicular artery crosses the posterior tibial condyle immediately posterior to the (blank) ligament and the (blank) muscle and immedately anterior to the (blank) muscle.
12. Be prepared to discuss specific arterial routes that blood could follow from the thigh to the leg without involving the middle 1/3 of the popliteal artery. This discussion requires knowledge of the (blank) anastomsis.
13. Use superficial/deep terminology to complete the following sentence. Within the adductor canal the femoral artery is (blank) to the femoral vein whereas within the popliteal fossa the popliteal artery is (blank) to the popliteal vein. Use anterior/posterior terminology to complete the following sentence. Within the adductor canal the femoral artery is (blank) to the femoral vein whereas within the popliteal fossa the popliteal artery is (blank) to the popliteal vein. When might you prefer to use superficial/deep terminology and when might you prefer to use anterior/posterior, medial/lateral, and superior/inferior terminology?
14. The most superior aspect of the hamstrings receive arterial supply from the (blank) artery, a branch of the (blank) artery. The most inferior aspect of the hamstrings receive arterial supply form the (blank) artery, a continuation of the (blank) artery. The middle aspect of the hamstrings receive arterial supply from the (blank) arteries, branches of the (blank) artery.
15. The is a small longitudinal artery that passes the entire length of the posterior compartment of the thigh. The upper 1/3 of this artery is augmented by the (blank) branch of the (blank) artery. The middle 1/3 of this artery is augmented the (blank) branches of the (blank) artery. The lower 1/3 of this artery is augmented by unnamed branches of the (blank) artery. The artery that is the focus of this question forms an arterial complex around the (blank)(blank).
16. What muscle(s) would be involved in flexion of the knee when the hip is extended?
17. What is the primary source of blood to the posterior compartment of the thigh?

Essay

1. What is the primary nerve supply to the anterior, medial, and posterior compartment of the thigh?
2. What is the primary vascular supply to the anterior, medial, and posterior compartment of the thigh?
3. Discuss contents of the popliteal fossa as they enter/leave the boundaries of the fossa.
   • superior lateral:
   • superior medial:
   • inferior lateral:
   • inferior medial:
   • superior:
   • inferior:
   • anterior:
   • posterior:
   • Note: Structures passing the posterior boundary may challenge you. Think about lymphatic vessels and veins.
4. Discuss the anatomy of the popliteal fossa. Include a statement of the boundaries (6 in number) and anatomical relations of each boundary. Discuss structures entering and leaving the popliteal fossa. Include the relations of these structures both within the fossa and at the boundaries of the fossa.
5. What is the arterial supply to the sciatic nerve? Consider superior, intermediate, and inferior
6. What is the vascular supply to the hamstrings. Discuss the parent vessels, key relations, and fascial barriers that are involved.
7. Discuss the contribution (if any) of each compartment of the thigh to flexion of the knee.
8. Discuss the arterial supply to the sciatic nerve. Discuss the arterial supply to the posterior compartment of the thigh.

• Set DENYTOPICVIEW =