Lecture Notes - Hip & Posterior Thigh & Leg

Osteology:

• Ilium
  • Post. sup. iliac spine - dimple at S2
• Femur
  • Greater trochanter - for glut. med. & min.
    
  • Gluteal tuberosity - for part of glut. max.
    
  • Linea aspera - adductors & vasti
    
  • Intertrochanteric crest - posterior
    
  • Intertrochanteric line - anterior
    
  • Trochanteric fossa - posterior
• Tibia
  • Soleal line - posterior surface
    
  • Medial malleolus
• Fibula
  • Lateral malleolus
• Foot
  • Tarsal bones
    
  • Calcaneus
    • Tuberosity - calcaneal tendon
      
    • Sustentaculum tali - flex. hallucis longus passes beneath
  • Talus
    • Navicular
      
    • Cuboid
      
    • Cuneiforms (medial, intermediate, lateral)
  • Metatarsals
    
  • Phalanges - 2 in hallux, 3 in other toes
    

Superficial Structures of the Posterior Lower Limb

• Superficial Veins
  • Lesser saphenous vein - post. to lateral malleolus; drains to popliteal v.
  • Perforating veins - to deep veins
  • Varicose veins
• Cutaneous Nerves
  • Posterior femoral cutaneous - from sacral plexus (S1-3); deep to fascia lata; inferior cluneal brs.; perineal br.
  • Sural cutaneous - medial & lateral - from tibial & common fibular
  • Sural - formed mid-calf by union of brs. of med. & lat. sural
    • Sural nerve graft - piece taken to repair nerve injured elsewhere

Muscles of lateral thigh (gluteal region):

• Gluteus maximus
  
• Gluteus medius
  
• Gluteus minimus
  
• Tensor fasciae latae
  
• Piriformis - key to gluteal region
  
• Obturator internus tendon & muscle
  
• Superior gemellus & inferior gemellus
  
• Quadratus femoris

Muscles of posterior thigh (hamstrings):

• Semitendinosus - to pes anserinus
  
• Semimembranosus
  
• Biceps femoris - innervated by tibial (long head) & common fibular (short head)

Nerves:

• Sacral plexus - L4-S4
  
• Superior gluteal n. (L4-5, S1) - to gluteus medius & minimus & tensor fascia lata
  
• Sciatic n. (L4-S3) - tibial & common fibular nerves may be separate (13%)
  
• Posterior femoral cutaneous n. (S1-3) - deep to fascia lata
  
• Perforating cutaneous nerve
  
• Inferior gluteal n. (L5, S1-2) - only gluteus maximus
  
• Pudendal n. (S2-4)
  
• Nerve to obturator internus - also reaches superior gemellus
  
• Nerve to quadratus femoris - also reaches inferior gemellus

Arteries & Veins:

• Superior gluteal - from post. div. of internal iliac; passes above piriformis; superficial br. supplies gluteus maximus
  
• Inferior gluteal - from ant. div. int. iliac; passes below piriformis
  
• Internal pudendal - from ant. div. int. iliac; passes below piriformis
  
• Perforating brs. of deep femoral - to cruciate anastomosis & post. thigh

Popliteal Fossa:

• Boundaries:
  • medially - semitendinosus & semimembranosus
    
  • laterally - biceps femoris
    
  • inferiorly - gastrocnemius
    
  • roof - popliteal fascia
• Contents:
  • Tibial nerve
    • Medial sural cutaneous
  • Common fibular nerve
    • Lateral sural cutaneous
  • Popliteal vein - superficial (post.) to artery; receives lesser saphenous
    
  • Popliteal artery
    • Sural branches - to gastrocnemius
      
    • Genicular arteries:
      • Superior medial & lateral
        
      • Middle
        
      • Inferior medial & lateral
  • Popliteal lymph nodes

Leg - posterior compartment:

• Superficial muscles
  • Triceps surae m. - calcaneal tendon
    • Gastrocnemius m.
      
    • Soleus m.
  • Plantaris m.
• Deep muscles - deep to transverse intermuscular septum
  • Popliteus m.
    
  • Flexor digitorum longus m.
    
  • Tibialis posterior m.
    
  • Flexor hallucis longus m.
• Flexor retinaculum - thickening of crural fascia
• Blood supply
  • Posterior tibial a.
    • Fibular a. - lies deep to flexor hallucis longus
• Nerve
  • Tibial n.