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MSK Exam 2 > Posterior Thigh & Popliteal Fossa > Flashcards

Posterior Thigh & Popliteal Fossa Flashcards

1
Q

What is the common name of the posterior thigh muscles?

A

Hamstrings

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2
Q

What are the muscles in the posterior compartment of the thigh?

A

Biceps Femoris M. (Long and short head)
Semitendinosus M.
Semimembranosus M.

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3
Q

What is the common proximal attachment for the posterior thigh muscles?

A

Ischial Tuberosity

***All except short head of biceps femoris

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4
Q

What is the common innervation of the posterior thigh muscles?

A

Tibial N. (division of Sciatic N.)

***All except short head of biceps femoris

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5
Q

What are the common functions of the posterior thigh muscles?

A

Leg flexion at knee

Thigh extension at hip (except short head of biceps femoris)

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6
Q

This muscle is located on the posteromedial aspect of the thigh and lies on the Semimembranosus M. throughout its entire length.

A

Semitendinosus M.

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7
Q

The Semitendinosus M. shares a proximal tendon with what other muscle?

A

Biceps Femoris M.

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8
Q

The Semitendinosus M. ends 2/3 down the thigh with a long, cord-like tendon that terminates as part of the…

A

Pes Anserinus

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9
Q

What are the actions of the Semitendinosus M.?

A

Flex leg
Extend thigh
Medially rotate flexed leg

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10
Q

What is the innervation of the Semitendinosus M.?

A

Tibial division of the sciatic nerve

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11
Q

This is a 3-fingered conjoined tendon that inserts on the anteromedial thigh. It is a common insertion for three muscles, each from a different compartment of the thigh.

A

Pes anserinus

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12
Q

What are the muscles that insert into Pes Anserinus, from anterior to posterior (superficial to deep)?

A

Sartorius M. (anterior compartment – Femoral N.)
Gracilis M. (medial compartment – Obturator N.)
Semitendinosus M. (posterior compartment – Tibial N.)

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13
Q

Pes Anserinus is superficial to what ligament?

A

Medial (Tibial) Collateral Ligament

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14
Q

This is the term for the inflammation of the anserine bursa located between the Pes Anserinus and MCL (often due to overuse or trauma). Results in constant, aching pain aggravated by activity (i.e., climbing stairs) specifically flexion and internal rotation of the knee.

A

Pes Anserine Bursitis

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15
Q

This muscle is on the posteromedial aspect of the thigh and is partly overlapped by the Semitendinosus M. and the deep surface lies on the Adductor Magnus M.

A

Semimembranosus M.

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16
Q

The Semimembranosus M. has a long, flat membranous tendon at the proximal attachment on the _______ _______. It inserts distally on the posterior part of the _______ _______ _______.

A

Ischial Tuberosity

Medial Tibial Condyle

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17
Q

What are the actions of the Semimembranosus M.?

A

Flex leg
Extend thigh
Medially rotate flexed leg

***Same as Semitendinosus M.

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18
Q

What innervates the Semimembranosus M.?

A

Tibial Division of the sciatic nerve

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19
Q

The distal tendon of the Semimembranosus M. divides into two main parts, which are…

A

Medial Tibial Condyle (muscle attachment)

Oblique Popliteal Ligament

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20
Q

The Oblique Popliteal Ligament reinforces the intercondylar portion of the knee joint capsule and forms part of the floor for the…

A

Popliteal Fossa

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21
Q

This muscle is located on the posterolateral aspect of the thigh and is composed of two heads arising from two distinct origins and sharing a common insertion.

A

Biceps Femoris M.

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22
Q

The Long Head of Biceps Femoris M. originates at the Ischial Tuberosity and inserts onto the…

A

Lateral aspect of Fibular head

***Same as short head

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23
Q

What are the actions of the Long Head of the Biceps Femoris M.?

A

Flex leg
Extend thigh
Laterally rotate flexed leg

***Remember, Semitendinosus and Semimembranosus both MEDIALLY rotated flexed leg

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24
Q

What innervates the Long Head of the Biceps Femoris M.?

A

Tibial division of the sciatic nerve

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25
Q

What nerve is located deep to the Long Head of the Biceps Femoris N.?

A

Sciatic N.

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26
Q

The Short Head of the Biceps Femoris M. inserts on the lateral aspect of the Fibular head, just like the Long head, but it originates on the…

A

Lateral lip of linea aspera

Lateral supracondylar line

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27
Q

What are the actions of the Short Head of the Biceps Femoris M.?

A

Flex leg
Laterally rotate flexed leg

***Remember, only hamstring muscle that does not extend thigh

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28
Q

What innervates the Short Head of the Biceps Femoris M.?

A

Common Fibular N.

***Remember, only hamstring muscle not innervated by Tibial N.

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29
Q

This muscle is located in the medial compartment of the thigh, but has a “hamstring portion” that runs vertically from the hip to the distal femur.

A

Adductor Magnus M.

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30
Q

The posterior surface of the Adductor Magnus M. lies on what muscle in the posterior thigh?

A

Semimembranosus M.

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31
Q

Between the adductor and hamstring portions of the Adductor Magnus M., this is a hole that is the termination of the Adductor Canal. It allows passage of femoral vessels from anterior to posterior thigh.

A

Adductor Hiatus

***Remember, Adductor Canal runs from apex of Femoral Triangle to the Adductor Hiatus

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32
Q

The hamstring portion of the Adductor Magnus M. originates on the Ischial Tuberosity and inserts on the…

A

Adductor Tubercle on Medial Condyle (Femur)

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33
Q

What innervates the hamstring portion of the Adductor Magnus M.?

A

Tibial N.

***Adductor portion innervated by Posterior Division of Obturator N.

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34
Q

A hamstring injury typically refers to a muscle strain or tear, but can also refer to hamstring tendinopathy. It can also involve an avulsion fracture from the…

A

Ischial Tuberosity

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35
Q

What grade of hamstring injury is being described?

    • Small disruption in structural integrity
    • Minor swelling and pain
    • No or minimal loss of strength
A

Grade I – Mild

36
Q

What grade of hamstring injury is being described?

    • Partial tears with some intact muscle fibers
    • Pain present
    • Definite loss of strength
A

Grade II – Moderate

37
Q

What grade of hamstring injury is being described?

    • Complete tear
    • Swelling, severe pain and typically with accompanied hematoma
    • Complete loss of motor function
A

Grade III – Severe

38
Q

These arteries are terminations of the Deep Femoral N. and supply the posterior thigh muscles and Adductor Magnus M. It courses from the anterior to posterior thigh by piercing the Adductor Magnus M.

A

Perforating Branches of Deep Femoral N.

39
Q

This branch of the Lateral Femoral Circumflex A. supplies the genicular anastomosis via the Superior Lateral Genicular A.

A

Descending Branch of Lateral Femoral Circumflex A.

40
Q

This artery arises from the Femoral A. in the Adductor Canal and supplies the genicular anastomosis via the Superior Medial Genicular A.

A

Descending Genicular A. (Saphenous and Articular branches)

41
Q

This vein branches off the Femoral V. just inferiorly to the Inguinal L.

A

Great Saphenous V.

42
Q

This nerve supplies the cutaneous innervation of the posterior thigh.

A

Posterior Femoral Cutaneous N.

***Directly off Lumbosacral Plexus – Ventral Rami S1-S3

43
Q

What branches off the Sciatic N. (L4-S3)?

A

Tibial N. (L4-S3)

Common Fibular N. (L4-S2)

44
Q

What are the spinal nerves contributing to each of the hamstring muscles?

A 
Tibial N. --
Long Head of Biceps Femoris M. (L5-S2)
Semitendinosus M. (L5-S2)
Semimembranosus M. (L5-S2)
Adductor Magnus hamstring portion (L4)

Common Fibular N. –
Short Head of Biceps Femoris M. (L5-S2)

45
Q

What is the action of the hamstring portion of the Adductor Magnus M.?

A

Extend thigh

46
Q

What are the boundaries of the Popliteal Fossa?

A

Superomedially – Semimembranosus and Semitendinosus
Superolaterally – Biceps femoris
Inferolaterally – Lateral head of Gastrocnemius
Inferomedially – Medial head of Gastrocnemius

47
Q

What is in the floor of the Popliteal Fossa?

A

Popliteal surface of Femur

Oblique Popliteal Ligament (from Semimembranosus Tendon)

Posterior surface proximal Tibia

48
Q

What are the contents of the Popliteal Fossa from superficial to deep?

A

Nerves
Popliteal V., branches, and LNs
Popliteal A. and branches

***Popliteal A. can be laying directly on bone

49
Q

This artery is a continuation of the Femoral A. after it passes through the Adductor Hiatus.

A

Popliteal A.

50
Q

What does the Popliteal A. terminate as?

A

Anterior Tibial A.

Posterior Tibial A.

51
Q

The Popliteal A. is the deepest structure in the Popliteal Fossa and runs close to the knee joint capsule. It also gives rise to the ________ branches surrounding the knee.

A

Genicular

52
Q

This is an important collateral circulation bypassing the Popliteal A. It’s used when the knee is fully extended or flexed for long periods of time and the Popliteal vessels ae occluded or narrowed.

A

Genicular Anastomosis

53
Q

The Genicular Anastomosis supplies what components of the knee joint?

A

Articular capsule

Ligaments

54
Q

The Popliteal V. lies superficial to and in the same fibrous sheath as the Popliteal A. It is the termination point of which vein?

A

Small Saphenous V.

55
Q

The Popliteal V. is also formed by the union of which veins near the inferior border of the Popliteus M.?

A

Anterior Tibial V.

Posterior Tibial V.

56
Q

What does the Popliteal V. become after traversing the Adductor Hiatus?

A

Femoral V.

57
Q

Cutaneous drainage of the posterior thigh drains into what LNs?

A

Superficial Popliteal LNs (along Small Saphenous V.)

58
Q

Deep leg and foot drains into what LNs?

A

Deep Popliteal LNs (along Popliteal V.)

59
Q

What is the path of LNs from the Superficial Popliteal LN to the Lumbar LN?

A 
Superficial Popliteal LNs --->
Deep Popliteal LNs --->
Deep Inguinal LNs --->
External Iliac LNs --->
Common Iliac LNs --->
Lumbar (Caval) LNs
60
Q

T/F. The Sciatic N. usually ends at the inferior angle of the Popliteal Fossa and divides into the Tibial N. and Common Fibular N. (more lateral).

A

False. The Sciatic N usually ends at the superior angle of the Popliteal Fossa.

61
Q

This is the larger component of the Sciatic N. and descends centrally through the Popliteal Fossa. It is most superficial relative to the Popliteal A. and V.

A

Tibial N.

62
Q

The Tibial N. runs distally with what artery?

A

Posterior Tibial A.

63
Q

The Tibial N. also innervates skin on the posterior leg via what nerve branch?

A

Medial Sural Cutaneous N.

64
Q

This component of the Sciatic N. descends on the lateral side of the Popliteal Fossa, and medial to the Biceps Femoris M. It leaves the Popliteal Fossa by passing superficially to the lateral head of the Gastrocnemius.

A

Common Fibular N.

65
Q

This nerve winds around the head and neck of the Fibula and is susceptible to injury.

A

Common Fibular N.

66
Q

The Common Fibular N. innervates the anterior leg muscles via which branch?

A

Deep Fibular N.

67
Q

The Common Fibular N. innervates the lateral leg muscles via which branch?

A

Superficial Fibular N.

68
Q

The Common Fibular N. innervates the skin on the posterolateral leg via which branch?

A

Lateral Sural Cutaneous N.

69
Q

This is a cutaneous nerve of the posterior leg and lateral aspect of the foot and ankle. It is composed of the Medial Sural Cutaneous N. from the Tibial N., and the Sural Communicating Branch from the Lateral Sural Cutaneous N. branch of the Common Fibular N.

A

Sural N.

***Runs inferiorly with Small Saphenous V.

70
Q

This is the most common type of distal femoral fractures and they occur transversely across the shaft.

A

Metaphyseal fractures

71
Q

A Physical fracture is a transverse fracture involving the epiphyseal plate. It is commonly described by what classification system?

A

Salter-Harris Classification (Types 1-5)

72
Q

What are the Salter-Harris Classification fracture types?

A

Type I – Through growth plate

Type II – Through growth plate and metaphysis

Type III – Through growth plate and epiphysis

Type IV – Through growth plate, metaphysis, and epiphysis

Type V – Crush injury of growth plate

73
Q

Why can posterior displacement in a distal femoral fracture disrupt neurovasculature?

A

Due to its close proximity to femur in popliteal fossa

74
Q

Describe a vascular injury in a distal femoral fracture.

A

Swelling in popliteal space
Absent/diminished dorsalis pedis or posterior tibial pulses
Slow distal capillary refill
Cold, pale feet

75
Q

Describe a nerve injury in a distal femoral fracture.

A

Motor injury with foot drop

Sensory deficits to dorsal or plantar foot

76
Q

Distal femoral fractures can cause Acute Compartment Syndrome, which is what?

A

Increased pressure in a closed fascial compartment

***Most commonly due to hemorrhage and/or edema

77
Q

What are symptoms of Acute Compartment Syndrome?

A

Persistent deep ache or burning pain
Paresthesia
Pain with passive stretch
Muscle weakness

78
Q

These are caused by swelling in the Popliteal Fossa due to enlargements of the Gastrocnemius-Semimembranosus Bursa. They often communicate with knee joint space and contain synovial fluid. Asymptomatic.

A

Popliteal (Baker’s) Cysts

79
Q

Popliteal (Baker’s) Cysts are associated with what?

A

Degenerative and inflammatory joint disease or injury

80
Q

What happens when there is an enlargement of a Popliteal (Baker’s) Cyst?

A

Presents similar to DVT –

Erythema
Edema due to vein compression
Ischemia due to arterial compression
Nerve entrapment
Positive Homan's sign
81
Q

What happens when there is a rupture of a Popliteal (Baker’s) Cyst?

A

Simulates thrombosis or muscle rupture –

Warmth, tenderness and erythema
Ecchymoses (bruising)
Compartment syndromes
May be indolent with only edema

82
Q

This is a localized enlargement of an artery due to weakening of the arterial wall. Most common in Popliteal A. and involves all three layers of the vessel wall.

A

Peripheral aneurysm

83
Q

Peripheral aneurysm can cause symptoms due to…

A

Thromboembolism
Mass effect
Rupture

84
Q

This complication presents with:

    • Claudication or Ischemic pain at rest
    • Sensory/motor nerve deficit
    • Severe pain behind knee
A

Peripheral aneurysm

85
Q

This is caused by atherosclerosis (buildup of cholesterol in arterial wall) leading to peripheral artery occlusion. A lack of blood flow leads to pain the affected muscle groups.

A

Peripheral Artery Disease

86
Q

This complication presents with:

    • Claudication
    • Ischemic pain at rest
    • Severe diffuse pain
    • Nonhealing ulcer
    • Gangrene
A

Peripheral Artery Disease

MSK Exam 2 (26 decks)

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