Lecture Notes - Hip & Posterior Thigh & Leg

The streaming video of the 2004-5 lab overview is available on the web (password protected). The computer presentation used by Dr. Gest in lecture is available on the web (password protected). You can also download the PowerPoint presentation to print or review.

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
    

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.

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