DOCSLIB.ORG

Isolated Popliteus Muscle Rupture with Neurovascular Compression Requiring Surgical Decompression

Total Page：16

File Type：pdf, Size：1020Kb

Download full-text PDF Read full-text
Isolated Popliteus Muscle Rupture with Neurovascular Compression Requiring Surgical Decompression (aspects of trauma • a case report) Isolated Popliteus Muscle Rupture With Neurovascular Compression Requiring Surgical Decompression Matthew Bollier, MD, Todd Ream, MD, and Gregory Hodgman, MD he tibial nerve, poplite- We report the unique case of an CASE REPORT al artery, and popliteal isolated popliteus muscle rupture A 34-year-old police officer pre- vein are superficial to the that led to compression of the tibial sented to the emergency depart- Tpopliteus muscle as they nerve in the popliteal fossa requir- ment with a 2-day history of excru- exit the popliteal fossa deep to ing surgical decompression. ciating posterior left knee pain. the fibrous soleus arch (Figure 1). The popliteus muscle forms the He described a twisting injury to There are 9 case reports of tibial floor of the popliteal fossa cours- his flexed left knee while helping a nerve compression in the popli- ing obliquely across the posterior motorist change a tire 2 weeks prior. teal fossa with etiologies includ- tibia with a tendinous insertion on There was an immediate onset of ing popliteus muscle rupture, mass the lateral femoral condyle anterior posterior knee pain, but it resolved lesion, or anomalous course of the and inferior to the lateral collateral over several hours. During the 2 gastrocnemius.1-9 When masses, ligament insertion.10-13 The poplit- days prior to emergency depart- fibrous bands, or swelling com- eus muscle functions as the primary ment evaluation, he reported wors- press the nerve and vein against the internal rotator of the tibia, unlock- ening posterior leg pain, weakness, rigid soleus arch, clinical symptoms ing the knee during early flexion.14-15 and an inability to bear weight. develop. There are 4 case reports It also is a static and dynamic stabi- Right knee and tibia/fibula radio- of a popliteus muscle injury caus- lizer of the lateral side of the knee. graphs showed no fracture or bony ing tibial nerve palsy, but surgical Although most popliteus injuries decompression of this problem has are part of a complex posterolateral not been described previously.1-4 corner knee injury, isolated tendon avulsions and muscle belly rup- Dr. Bollier is Assistant Professor, tures have been described.1-10,16-20 Department of Orthopaedic Surgery, In this case, an isolated poplit- University of Iowa, Iowa City, Iowa. He eus muscle rupture from a knee was Orthopaedic Surgery Resident, external rotation injury caused Michigan State University, Kalamazoo Center for Medical Studies, Kalamazoo, an inflammatory mass effect in Michigan, at the time the article was the popliteal fossa, compressing written. the tibial nerve against the soleus Dr. Ream is Orthopaedic Surgeon, arch leading to a progressive tibial Kalamazoo Orthopaedic Clinic, and nerve palsy and multiple deep vein Clinical Assistant Professor, Michigan State University, Kalamazoo, Michigan. thrombosis (DVT). This interest- Dr. Hodgman is Radiologist, Advanced ing case report demonstrates the Radiology Services P.C., Kalamazoo, anatomy of the posterior aspect of Michigan. the knee, highlights the importance of a thorough physical exam and Address correspondence to: Matthew Bollier, MD, Department of Orthopaedic advanced imaging techniques, and Surgery, University of Iowa Hospitals and reviews the current literature on Figure 1. Popliteal fossa anatomy. The Clinics, 2701 Prairie Meadow Dr, Iowa neurovascular compression after a tibial nerve, popliteal artery, and popli- City, IA 52242 (tel, 319-467-8254; e-mail, popliteus muscle rupture. teal vein are visualized directly super- [email protected]). The authors have obtained the ficial to the popliteus muscle as they course distally under the soleus arch. Am J Orthop. 2010;39(12):588-591. patient’s written informed consent Abbreviations: a, artery; m, muscle; Copyright Quadrant HealthCom Inc. for print and electronic publication n, nerve; v, vein. Figure 1 provided by 2010. All rights reserved. of the case report. Matthew Morrey. 588 The American Journal of Orthopedics® M. Bollier et al Figure 2. Patient presented to the emer- gency room with a large effusion of the left knee. abnormalities. Laboratory analysis Figure 3. T1-weighted sagittal magnetic resonance imaging of left knee after intrave- revealed an erythrocyte sedimenta- nous gadolinium reveals popliteus muscle enlargement with no enhancement, and edema posterior to the muscle. tion rate of 55 mm/h, C-reactive protein of 13.5 nmol/L, and a white blood cell count of 10.9×109/L. After the emergency department evaluation, the orthopedic sur- gery service was consulted. Initial questioning revealed a burning posterior knee pain that radiated distally along the posterior left leg, plantar foot dysesthesias, and a knee effusion. The patient had an elevated temperature (38.5°C). He appeared anxious and couldn’t find a comfortable position. He had a large knee effusion and painless passive knee range of motion from Figure 4. T1-weighted coronal magnetic resonance imaging of left knee after intrave- 0° to 45° (Figure 2). Posterolateral nous gadolinium shows popliteus muscle hypertrophy with no enhancement. calf swelling and tenderness were present, and the patient reported revealed a white blood cell count on therapeutic enoxaparin (1 mg/ posterior leg discomfort with pas- of 10.0×109/L, normal glucose and kg) to treat DVT and was admitted sive ankle dorsiflexion and resisted lactate dehydrogenase levels, and to the hospital for observation and ankle plantarflexion. There was no organism present with bacte- pain control. decreased sensation to light touch rial cultures. A lower-extremi- Eighteen hours after admission, and pinprick on the lateral plantar ty ultrasound showed deep vein the patient required an increased foot. The gastrocnemius and soleus thrombosis in the anterior tibial, amount of intravenous pain med- muscles showed grade 5/5 strength deep peroneal, and posterior tibial ications and reported worsening by manual muscle testing, but flex- veins. Magnetic resonance imag- posterior leg pain. Examination or hallucis longus muscle strength ing (MRI) with intravenous gado- revealed decreased sensation to was grade 3/5. The remainder of linium of the left knee and left light touch and pinprick involving the neurovascular examination calf demonstrated popliteus muscle the entire plantar foot. Manual was normal. Knee stability testing swelling with no enhancement and muscle testing showed grade 0/5 showed symmetric findings com- surrounding edema (Figures 3–5). flexor hallucis longus strength and pared to the contralateral knee with The MRI findings were consistent grade 2/5 gastrocnemious and sole- the Lachman test, posterior drawer with a popliteus muscle rupture us strength. The patient’s posterior test, varus/valgus stress test, and and subsequent necrosis. An asso- calf compartment was soft but dif- Dial test. There was no erythema, ciated inflammatory mass effect fusely tender to palpation. He had fluctuance, or wounds. Calf com- and popliteus muscle swelling com- increased discomfort with passive partments were soft. pressed the nerve and vein against ankle dorsiflexion. A knee aspiration was performed the fibrous soleus arch leading to The patient was felt to have a and 30 mL of clear yellow fluid an acute tibial neuropathy and mul- progressive tibial neuropathy and was obtained. Laboratory analysis tiple DVT. The patient was started urgent surgical decompression was December 2010 589 Isolated Popliteus Muscle Rupture With Neurovascular Compression planned. He was placed in a prone position for a posterior approach to the knee. A lazy S-shaped inci- sion was made, curving from distal medial to proximal lateral. After dissecting down to the fascia, the sural nerve and small saphenous vein were identified and traced proximally. The fascia was split in line with the incision, and the dissection proceeded between the medial and lateral heads of the gastrocnemius muscle. The tibial nerve was identified and found to be pale, atrophic, and flattened at Figure 5. T1-weighted axial magnetic resonance imaging of left knee after intravenous the soleus arch (Figure 6). The gadolinium reveals popliteus muscle enlargement with no enhancement, and edema posterior to the muscle. soleus arch was divided longitu- dinally to decompress the nerve and vein. Necrotic-appearing pop- liteus muscle was débrided (Figure 7). The skin was closed, and the patient’s leg was placed in a soft dressing. The patient was made non–weight bearing for 2 weeks and knee range of motion was limited to 45° of flexion. The neu- ropathic pain resolved immediately after surgery. Postoperative vascular surgery consultation was obtained, and the Figure 6. The patient is in the prone Figure 7. Popliteal fossa. The soleus patient was started on a 3-month position for posterior approach to the arch is divided longitudinally and the course of coumadin to treat DVT. left knee. The tibial nerve is pale, atro- necrotic popliteus muscle is débrided. phic, and compressed at the soleus At 2 weeks, weight bearing and knee arch. range of motion were progressed. full active knee range of motion At 2 months, the patient had full mon, limited to various case with no knee effusion, ligamentous knee range of motion and ambulat- reports.1-10,16-20 Most popliteus laxity, or mechanical symptoms. ed independently. He still reported muscle injuries are part of a multi- Conservative treatment involves decreased plantar foot sensation. ligament knee injury involving the injections, quadriceps strengthen- He had grade 4/5 gastrocnemius posterolateral corner.21 Less than ing, stretching, and rest. muscle strength and grade 1/5 flexor 10% of popliteus muscle injuries Popliteus tendon avulsion is hallucis longus muscle strength. He are isolated.16,22 Several patterns of more common than muscle belly was able to return to active duty as isolated popliteus injury have been injuries and typically involves a a police officer. described: a tendon avulsion or sudden external rotation force to a At 9 months, medial plantar sen- rupture, muscle belly rupture, or partially flexed knee.16 These avul- sation had returned, but the patient popliteus tendinitis.
Load more

Recommended publications
  • Bilateral Anomalous Muscle in the Popliteal Fossa & Its Clinical
    International Journal of Anatomy and Research, Int J Anat Res 2014, Vol 2(4):614-16. ISSN 2321- 4287 Case Report DOI: 10.16965/ijar.2014.501 BILATERAL ANOMALOUS MUSCLE IN THE POPLITEAL FOSSA & ITS CLINICAL SIGNIFICANCE Sowmya S *, Meenakshi Parthasarathi, Sharmada KL, Sujana M. Department of anatomy, Bangalore Medical College & Research Institute, Bangalore, India. ABSTRACT Muscle variation may occur due to genetic or developmental causes. Some variations may compromise the vascular, muscular or nervous system in the region. Bilateral muscle variation in popliteal fossa is very rare. In present study an instance of bilateral muscle variation in popliteal fossa, arising from different muscles like gastrocnemius and from biceps femoris is recorded. There is no report of such variations. These observations are rare of its kind because of bilateral asymmetrical presence and difference in the origins in different legs. This is the first report as for the literatures available. Clinical and functional importance of such variation is discussed with the morphological aspects of this anomalous muscle. KEY WORDS: Popliteal fossa, Gastrocnemius, Biceps femoris, Popliteal Artery Entrapment Syndrome. Address for Correspondence: Dr.Sowmya S, Assistant Professor, Department of Anatomy, Bangalore Medical College & Research Institute, Bangalore-560002, India. Mobile: +919482476545. E-Mail: [email protected] Access this Article online Quick Response code Web site: International Journal of Anatomy and Research ISSN 2321-4287 www.ijmhr.org/ijar.htm Received: 08 Sep 2014 Peer Review: 08 Sep 2014 Published (O):31 Oct 2014 DOI: 10.16965/ijar.2014.501 Accepted: 22 Sep 2014 Published (P):31 Dec 2014 INTRODUCTION Insertion of muscle slips from biceps femoris into gastrocnemius and into tendocalcaneus have The popliteal fossa is a rhomboidal region been reported [3].
    [Show full text]
  • The Anatomy of the Posterolateral Aspect of the Rabbit Knee
    Journal of Orthopaedic Research ELSEVIER Journal of Orthopaedic Research 2 I (2003) 723-729 www.elsevier.com/locate/orthres The anatomy of the posterolateral aspect of the rabbit knee Joshua A. Crum, Robert F. LaPrade *, Fred A. Wentorf Dc~~ur/niiviiof Orthopuer/ic Surgery. Unicrrsity o/ Minnesotu. MMC 492, 420 Dcluwur-c Si. S. E., Minnwpoli,s, MN 55455, tiSA Accepted 14 November 2002 Abstract The purpose of this study was to determine the anatomy of the posterolateral aspect of the rabbit knee to serve as a basis for future in vitro and in vivo posterolateral knee biomechanical and injury studies. Twelve nonpaired fresh-frozen New Zealand white rabbit knees were dissected to determine the anatomy of the posterolateral corner. The following main structures were consistently identified in the rabbit posterolateral knee: the gastrocnemius muscles, biceps femoris muscle, popliteus muscle and tendon, fibular collateral ligament, posterior capsule, ligament of Wrisberg, and posterior meniscotibial ligament. The fibular collateral ligament was within the joint capsule and attached to the femur at the lateral epi- condyle and to the fibula at the midportion of the fibular head. The popliteus muscle attached to the medial edge of the posterior tibia and ascended proximally to give rise to the popliteus tendon, which inserted on the proximal aspect of the popliteal sulcus just anterior to the fibular collateral ligament. The biceps femoris had no attachment to the fibula and attached to the anterior com- partment fascia of the leg. This study increased our understanding of these structures and their relationships to comparative anatomy in the human knee.
    [Show full text]
  • The Square Flap Technique for Burn Contractures: Clinical Experience and Analysis of Length Gain
    Annals of Burns and Fire Disasters - vol. XXXI - n. 4 - December 2018 THE SQUARE FLAP TECHNIQUE FOR BURN CONTRACTURES: CLINICAL EXPERIENCE AND ANALYSIS OF LENGTH GAIN DOUBLE LAMBEAU RHOMBOÏDE POUR BRIDE SÉQUELLAIRE DE BRÛ- LURE: EXPÉRIENCE PRATIQUE ET ANALYSE DE LA LONGUEUR GAGNÉE Hifny M.A. Department of Plastic Surgery, Faculty of Medicine, Qena University Hospital, South Valley University, Egypt SUMMARY. Post-burn contractures, affecting the joints especially, are demanding problems. Many surgical techniques have been designated for burn contracture release. The aim of this study is to investigate the efficiency of the square flap technique to release a post-burn scar contracture, and assess the post-operative length gain that can be achieved by simple mathematical calculation. In this study, sixteen patients with linear contracture bands were treated with the square flap tech- nique. The anatomical distribution of the contractures was: axilla, cubital fossa, flank, perineum and popliteal fossa. Scar maturity ranged from 4 months - 9 years. Square flap width and contracture band length before and immediately after surgery were recorded by simple mathematical calculation. Flap complication was assessed. Patient satisfaction was also assessed during the follow-up period. All square flaps were effective in lengthening the contracture bands. The length of the contracture that was released ranged from 2 to 6 cm. The gain in length provided with this technique ranged from 212 to 350%, average 247%, and adequate contracture release was achieved in all cases postoperatively. All square flaps healed uneventfully except for one (6%), which demonstrated limited epidermolysis that healed by secondary intention. The fol- low-up interval ranged from 6 months to 1.5 years.
    [Show full text]
  • Popliteal Fossa
    POPLITEAL FOSSA Dr Kaweri Dande Resident Department Of Anatomy King George’s Medical University, UP, Lucknow DISCLAIMER: • The presentation includes images which are either hand drawn or have been taken from google images or books. • They are being used in the presentation only for educational purpose. • The author of the presentation claims no personal ownership over images taken • from books or google images. • However, the hand drawn images are the creation of the author of the presentation Learning objectives • By the end of this teaching session all the students must be able to correctly:- • Describe and demonstrate the location of the popliteal fossa • Enumerate the boundaries, roof and floor of the popliteal fossa • Enumerate the contents of the popliteal fossa • Describe the relations of the popliteal fossa • Draw a labelled diagram of the popliteal fossa • Describe the applied anatomy of the popliteal fossa Preface • Important transition area • Between thigh and leg • Passes structure between two Location • Diamond shaped space • Behind knee joint • Formed between muscles • Posterior compartment of thigh and leg Outline of right popliteal fossa Boundaries • Superolaterally: biceps femoris • Superomedially: semitendinosus, semimembranosus supplemented: gracilis, sartorius, adductor magnus • Inferolaterally: lateral head of gastrocnemius, Plantaris • Inferomedially: medial head of gastrocnemius Floor Above downwards • Popliteal surface of femur • Capsule of knee joint • Oblique popliteal ligament • Popliteal fascia • Popliteal muscle
    [Show full text]
  • DEPARTMENT of ANATOMY IGMC SHIMLA Competency Based Under
    DEPARTMENT OF ANATOMY IGMC SHIMLA Competency Based Under Graduate Curriculum - 2019 Number COMPETENCY Objective The student should be able to At the end of the session student should know AN1.1 Demonstrate normal anatomical position, various a) Define and demonstrate various positions and planes planes, relation, comparison, laterality & b) Anatomical terms used for lower trunk, limbs, joint movement in our body movements, bony features, blood vessels, nerves, fascia, muscles and clinical anatomy AN1.2 Describe composition of bone and bone marrow a) Various classifications of bones b) Structure of bone AN2.1 Describe parts, blood and nerve supply of a long bone a) Parts of young bone b) Types of epiphysis c) Blood supply of bone d) Nerve supply of bone AN2.2 Enumerate laws of ossification a) Development and ossification of bones with laws of ossification b) Medico legal and anthropological aspects of bones AN2.3 Enumerate special features of a sesamoid bone a) Enumerate various sesamoid bones with their features and functions AN2.4 Describe various types of cartilage with its structure & a) Differences between bones and cartilage distribution in body b) Characteristics features of cartilage c) Types of cartilage and their distribution in body AN2.5 Describe various joints with subtypes and examples a) Various classification of joints b) Features and different types of fibrous joints with examples c) Features of primary and secondary cartilaginous joints d) Different types of synovial joints e) Structure and function of typical synovial
    [Show full text]
  • Popliteal Masses Masquerading As Popliteal Cysts
    Ann Rheum Dis: first published as 10.1136/ard.43.1.60 on 1 February 1984. Downloaded from Annals ofthe Rheumatic Diseases, 1984, 43, 60-62 Popliteal masses masquerading as popliteal cysts H. T. GRIFFITHS, C. W. ELSTON, C. L. COLTON, AND A. J. SWANNELL From the Departments ofRheumatology, Orthopaedics and Pathology, City Hospital, Nottingham SUMMARY Two popliteal swellings, thought initially to be synovial cysts associated with arthritic knees, were found to be unrelated tumours of serious significance. In the presence of neurological signs or a large cyst in association with a noninflammed knee joint a disease other than a simple synovial cyst should be considered. A mass in the popliteal fossa may arise from a variety the left leg followed by cytotoxic chemotherapy. For of different causes including synovial. cysts, throm- the last 18 months she has had no antimitotic treat- bophlebitis, popliteal artery or vein aneurysms, gas- ment, and apart from her persisting rheumatoid arth- trocnemius haematomas, and neoplastic tumours. Of ritis she remains well. She walks with the aid of. a these the lesion most commonly associated with arth- foot-drop splint. ntis in the knee is a popliteal synovial cyst, or Baker's cyst. In certain circumstances a high index of suspi- CASE 2 cion should be maintained that despite the presence- A 69-year-old woman presented with a history of 12 of arthritis a popliteal mass may not be a synovial months of progressive, painless swelling of the right copyright. cyst. calf and politeal fossa. Over the preceding 4 years she Two cases are reported in which the initial diag- had noted mild pain in both knees but had suffered no nosis was of a synovial cyst, but at subsequent surgery other joint symptoms.
    [Show full text]
  • Popliteal Fossa, Back of Leg & Sole of Foot
    Popliteal fossa, back of leg & Sole of foot Musculoskeletal block- Anatomy-lecture 16 Editing file Color guide : Only in boys slides in Blue Objectives Only in girls slides in Purple important in Red Doctor note in Green By the end of the lecture, students should be able to: Extra information in Grey ✓ The location , boundaries & contents of the popliteal fossa. ✓ The contents of posterior fascial compartment of the leg. ✓ The structures hold by retinacula at the ankle joint. ✓ Layers forming in the sole of foot & bone forming the arches of the foot. Popliteal Fossa Is a diamond-shaped intermuscular space at the back of the knee Boundaries Contents Tibial nerve Common peroneal nerve Semitendinosus Laterally Medially Roof Floor From medial to lateral (above) (above) 1.Skin 1.popliteal surface 1. Popliteal vessels (artery/vein) biceps femoris. semimembranosus 2.superficial of femur 2. Small saphenous vein & semitendinosus fascia & deep 2.posterior ligament 3. Tibial nerve fascia of the of knee joint 4. Common peroneal nerve. (Below) (Below) thigh. 3.popliteus muscle. 5. Posterior cut. nerve of thigh Lateral head of Medial head of 6. Connective tissue & popliteal lymph gastrocnemius gastrocnemius nodes. & plantaris The deepest structure is popliteal artery.* (VERY IMPORTANT) CONTENTS OF THE POSTERIOR FASCIAL COMPARTMENT OF THE LEG The transverse intermuscular septum of the leg is a septum divides the muscles of the posterior Transverse section compartment into superficial and deep groups. Contents 1. Superficial group of muscles 2. Deep group of muscles 3. Posterior tibial artery transverse intermuscular 4. Tibial nerve septum Superficial group Deep group 1. Gastrocnemius 1.
    [Show full text]
  • Clinical Anatomy of the Lower Extremity
    Государственное бюджетное образовательное учреждение высшего профессионального образования «Иркутский государственный медицинский университет» Министерства здравоохранения Российской Федерации Department of Operative Surgery and Topographic Anatomy Clinical anatomy of the lower extremity Teaching aid Иркутск ИГМУ 2016 УДК [617.58 + 611.728](075.8) ББК 54.578.4я73. К 49 Recommended by faculty methodological council of medical department of SBEI HE ISMU The Ministry of Health of The Russian Federation as a training manual for independent work of foreign students from medical faculty, faculty of pediatrics, faculty of dentistry, protocol № 01.02.2016. Authors: G.I. Songolov - associate professor, Head of Department of Operative Surgery and Topographic Anatomy, PhD, MD SBEI HE ISMU The Ministry of Health of The Russian Federation. O. P.Galeeva - associate professor of Department of Operative Surgery and Topographic Anatomy, MD, PhD SBEI HE ISMU The Ministry of Health of The Russian Federation. A.A. Yudin - assistant of department of Operative Surgery and Topographic Anatomy SBEI HE ISMU The Ministry of Health of The Russian Federation. S. N. Redkov – assistant of department of Operative Surgery and Topographic Anatomy SBEI HE ISMU THE Ministry of Health of The Russian Federation. Reviewers: E.V. Gvildis - head of department of foreign languages with the course of the Latin and Russian as foreign languages of SBEI HE ISMU The Ministry of Health of The Russian Federation, PhD, L.V. Sorokina - associate Professor of Department of Anesthesiology and Reanimation at ISMU, PhD, MD Songolov G.I K49 Clinical anatomy of lower extremity: teaching aid / Songolov G.I, Galeeva O.P, Redkov S.N, Yudin, A.A.; State budget educational institution of higher education of the Ministry of Health and Social Development of the Russian Federation; "Irkutsk State Medical University" of the Ministry of Health and Social Development of the Russian Federation Irkutsk ISMU, 2016, 45 p.
    [Show full text]
  • Anatomy Flashcards: Hip and Thigh
    ANATOMY FLASHCARDS Hip and thigh Dear Anatomy Geek, Welcome to your Kenhub flashcards eBook. This eBook is laid out in a flashcard style format, which means that you can learn anatomy easily and on the go. Oh- and without having to deal with a tidal wave of handmade flashcards flying around. Result! So, how do I use this anatomy eBook? It couldn’t be simpler. On the first page, you will see an illustration of an anatomical structure along with a question asking you to identify it. Allow yourself a few seconds to recall the name of the structure you see as well as its purpose in the body. Once you think you’ve got it, flip the page. Here you will see the answer in English and Latin, as well as some additional information about the structure. It’s important to be honest with yourself. Did you get it right? If so, great! Move onto the next card. If not, make a note to come back to it later before you move onto the next card. And that’s it! It’s really that easy. Swipe the page to get started now. QUESTION What structure is shown here? Image by: Liene Znotina ENGLISH Lateral condyle of the femur LATIN Condylus lateralis femoris ORIGINS Popliteus muscle Image by: Liene Znotina QUESTION What structure is shown here? Image by: Liene Znotina ENGLISH Acetabulum LATIN Acetabulum Image by: Liene Znotina QUESTION What structure is shown here? Image by: Liene Znotina ENGLISH Psoas major muscle LATIN Musculus psoas major INSERTIONS Lesser trochanter INNERVATIONS Femoral nerve, Lumbar plexus FUNCTIONS Flexes the hip joint, externally rotates the hip
    [Show full text]
  • Back of Thigh
    Back of thigh Dr Garima Sehgal Associate Professor King George’s Medical University UP, Lucknow DISCLAIMER: • The presentation includes images which have been taken from google images or books. • The author of the presentation claims no personal ownership over these images taken from books or google images. • They are being used in the presentation only for educational purpose. Learning Objectives By the end of this teaching session on back of thigh – I all the MBBS 1st year students must be able to: • Enumerate the contents of posterior compartment of thigh • Describe the cutaneous innervation of skin of back of thigh • Enumerate the hamstring muscles • List the criteria for inclusion of muscles as hamstring muscles • Describe the origin, insertion, nerve supply & actions of hamstring muscles • Describe origin, course and branches of sciatic nerve • Write a short note on posterior cutaneous nerve of thigh • Write a note on arteries and arterial anastomosis at the back of thigh • Discuss applied anatomy of back of thigh Compartments of the thigh Cutaneous innervation of back of thigh 1 4 2 3 Contents of Back of thigh Muscles: Hamstring muscles & short head of biceps femoris Nerves: Sciatic nerve & posterior cutaneous nerve of thigh Arterial Anastomosis: The Posterior Femoral Cutaneous Nerve (n. cutaneus femoralis posterior) Dorsal divisions of – S1, S2 & Ventral divisions of S2, S3 Exits from pelvis through the greater sciatic foramen below the Piriformis. Descends beneath the Gluteus maximus with the inferior gluteal artery Runs down the back of the thigh beneath the fascia lata, to the back of the knee and leg Posterior Femoral Cutaneous Nerve contd….
    [Show full text]
  • Does Skin Surface Temperature Variation Account for Buruli Ulcer Lesion Distribution?
    PLOS NEGLECTED TROPICAL DISEASES RESEARCH ARTICLE Does skin surface temperature variation account for Buruli ulcer lesion distribution? 1,2 3 4 Nicola K. Sexton-OatesID *, Andrew J. StewardsonID , Arvind Yerramilli , Paul D. 2 R. JohnsonID * 1 Department of Medicine, the University of Melbourne, Melbourne, Victoria, Australia, 2 Department of Infectious Diseases, Austin Health, Melbourne, Victoria, Australia, 3 Department of Infectious Diseases, Alfred Hospital and Central Clinical School, Monash University, Melbourne, Victoria, Australia, 4 Department of General Medicine, the Royal Melbourne Hospital, Melbourne, Victoria, Australia * [email protected] (NKSO); [email protected] (PDRJ) a1111111111 Abstract a1111111111 a1111111111 a1111111111 Background a1111111111 Buruli ulcer is a necrotising infection of skin and soft tissue caused by Mycobacterium ulcer- ans (M. ulcerans). Buruli ulcer most often occurs on limbs, and it is hypothesized this is explained by direct exposure to the environment. However, even on exposed areas Buruli ulcer is not randomly distributed. M. ulcerans prefers an in vitro temperature of 30±33ÊC and OPEN ACCESS growth is inhibited at higher temperatures. This study investigated whether variations in skin Citation: Sexton-Oates NK, Stewardson AJ, surface temperature distribution in healthy volunteers could partly account for Buruli ulcer Yerramilli A, Johnson PDR (2020) Does skin surface temperature variation account for Buruli lesion distribution. ulcer lesion distribution? PLoS Negl Trop Dis 14 (4): e0007732. https://doi.org/10.1371/journal. Methodology/Principal findings pntd.0007732 In this observational study, a thermal camera (FLIR E8) was used to measure skin surface Editor: Abdallah M. Samy, Faculty of Science, Ain temperature at the sternal notch and at 44 predetermined locations on the limbs of 18 human Shams University (ASU), EGYPT participants.
    [Show full text]
  • Surface Anatomy
    BODY ORIENTATION OUTLINE 13.1 A Regional Approach to Surface Anatomy 398 13.2 Head Region 398 13.2a Cranium 399 13 13.2b Face 399 13.3 Neck Region 399 13.4 Trunk Region 401 13.4a Thorax 401 Surface 13.4b Abdominopelvic Region 403 13.4c Back 404 13.5 Shoulder and Upper Limb Region 405 13.5a Shoulder 405 Anatomy 13.5b Axilla 405 13.5c Arm 405 13.5d Forearm 406 13.5e Hand 406 13.6 Lower Limb Region 408 13.6a Gluteal Region 408 13.6b Thigh 408 13.6c Leg 409 13.6d Foot 411 MODULE 1: BODY ORIENTATION mck78097_ch13_397-414.indd 397 2/14/11 3:28 PM 398 Chapter Thirteen Surface Anatomy magine this scenario: An unconscious patient has been brought Health-care professionals rely on four techniques when I to the emergency room. Although the patient cannot tell the ER examining surface anatomy. Using visual inspection, they directly physician what is wrong or “where it hurts,” the doctor can assess observe the structure and markings of surface features. Through some of the injuries by observing surface anatomy, including: palpation (pal-pā sh ́ ŭ n) (feeling with firm pressure or perceiving by the sense of touch), they precisely locate and identify anatomic ■ Locating pulse points to determine the patient’s heart rate and features under the skin. Using percussion (per-kush ̆ ́ŭn), they tap pulse strength firmly on specific body sites to detect resonating vibrations. And ■ Palpating the bones under the skin to determine if a via auscultation (aws-ku ̆l-tā sh ́ un), ̆ they listen to sounds emitted fracture has occurred from organs.
    [Show full text]