Lab Manual - Hip & Posterior Thigh & Leg Learning Objectives: 1.

Describe the anatomy of the lateral femoral (hip) region, including the gluteal muscles, their nerve supply, and their actions in locomotion. 2. Identify the sacral plexus, its general plan, and its major branches in the hip and posterior thigh regions. 3. Describe the muscular anatomy of the posterior thigh, its muscles, their nerve supply, and their actions in locomotion. 4. Predict the functional loss and cutaneous areas affected by a given nerve injury to the hip and posterior thigh region; or conversely, given a functional and/or cutaneous loss, be able to predict which nerve or nerves are involved and the probable level of the injury. 5. Define the popliteal fossa and give the spatial relationships of its contents. 6. Recall the general plan of the collateral circulation at the hip and knee. 7. Describe the arrangement, specializations and compartments of the fascia of the leg. 8. Identify the muscles of the posterior compartment of the leg and give their functional significance in locomotion. 9. Identify the vascular supply of the posterior compartment of the leg. 10. Identify the nerves of the posterior compartment of the leg, the muscles and cutaneous regions supplied by them, so that given a functional and/or cutaneous loss one can predict the nerve and the probable level of injury. Procedure: 2. Define the gluteus maximus and reflect it laterally. Clear the gluteal region of all superficial fascia. Define the gluteus maximus fascia and the gluteal aponeurosis covering the gluteus medius muscle. Define the gluteus maximus muscle. Reflect the muscle laterally from its origin on the sacrum and sacrotuberous ligament to expose the deeper structures. Care must be taken in removing it from the sacrotuberous ligament to not remove the ligament. Cut along its superior border to separate the gluteus maximus from the gluteal aponeurosis covering the gluteus medius. In reflecting the muscle do not injure deeper structures along its inferior border, especially the sacrotuberal ligament, the posterior femoral cutaneous and sciatic nerves. Note that most of the muscle is enclosed within the deep fascia. Now locate the tensor fasciae latae muscle. Slit open the fascia lata vertically and expose the muscle. Note that both gluteus maximus and tensor fasciae latae insert via the iliotibial tract of the fascia lata. Where does this attach? Now observe the other insertion of gluteus maximus into the gluteal tuberosity. 3. Reflect the gluteus medius and examine the superior gluteal vessels and nerve. Remove the gluteus medius fascia as far anterior as the anterior superior iliac spine. Trace the muscle to its insertion. Locate the superior gluteal artery and nerve coursing deep to the gluteus medius muscle; what is their source? This plane can be used to separate the

Note how it and the sacrotuberal ligament form the greater and lesser sciatic foramina. semitendinosus and semimembranosus muscles. Define the sacrospinal ligament. Through what foramen does it pass? Define the superior and inferior gemellus muscles. Dissect the hamstrings from origin to insertion Uncover and dissect the biceps femoris. Note the manner of attachment to the ischial tuberosity. Define the greater and lesser sciatic foramina and the structures traversing each. 5. noting specifically the bones entering into its formation and how the ligaments support the joint: long and short posterior sacroiliac. Locate the piriformis muscle and trace it to its insertion. and one from the common fibular division to the short head of biceps? . Note specifically the relation of biceps femoris to the sciatic nerve. the nerves supplying them. Read about the sacroiliac articulation. Consider the formation of the sacral plexus and trace its major branches. What is the innervation and blood supply to gluteus maximus? Now consider the insertions and actions of the gluteal muscles.gluteus medius from the underlying gluteus minimus. Trace the superior gluteal artery and nerve to the muscles supplied. interosseous sacroiliac. and the nerve to obturator internus and superior gemellus. including the tensor fasciae latae. which must be removed to see the structures clearly. Now observe the complete origin and course of the obturator internus muscle. Confirm its innervation. locate and define the quadratus femoris muscle. and anterior sacroiliac ligaments. vein and nerve and sciatic nerve. noting relations to the hip muscles. Clean the sacrotuberal ligament. 4. the internal pudendal artery and vein. Review completely the muscles. Reflect the gluteus medius from its origin and define the gluteus minimus. Trace semitendinosus to its insertion and complete the dissection of the pes anserinus. Trace the innervation to all muscles. Review the posterior femoral cutaneous nerve. What major action do these muscles have in common? Trace the sciatic nerve into the thigh. Do you find a branch from the tibial division of the sciatic nerve to adductor magnus. Inferior to the inferior gemellus muscle. is there a perforating cutaneous nerve and artery associated with it? Reflect the ligament from the ischial tuberosity and identify the following as they lie on the sacrospinal ligament: pudendal nerve. Locate the short head of biceps femoris muscle. Define the obturator internus tendon and trace to its insertion. What structures does each transmit? Review the course of the pudendal nerve and internal pudendal artery. Note that there is usually a web of fascia extending between the two ligaments. Identify the inferior gluteal nerve to the gluteus maximus. Through what foramen does it exit the pelvis? Note its relation to the superior gluteal neurovascular bundle and to the inferior gluteal artery. and the blood supply to the region. Note how the lumbosacral trunk and sacral nerves unite to form the sacral plexus.

open each compartment of the leg by cutting longitudinally through the crural fascia. plantaris and soleus muscles. Explore the popliteal artery. 8. Reflect the soleus and dissect the deep posterior compartment.Arteriogram of lower limb vessels 6. Remove the subcutaneous tissue of the posterior leg and expose the crural fascia. Dissect the popliteus muscle by removing its fascia. a thickening of the crural fascia. 7. Trace these tendons to the posterior side of the medial malleolus and deep to the flexor retinaculum. What is the triceps surae? Cut through the midpoint of the gastrocnemius and reflect it to expose the soleus and popliteus muscles. Cut through the septum. the adductor hiatus and the manner in which the vein and artery enter and leave the popliteal fossa. Open the superficial posterior compartment and dissect the gastrocnemius. Note the rearrangement of the tibialis posterior and flexor digitorum longus tendons. Note how the gastrocnemius and soleus (and sometimes plantaris) combine into a single tendon and insert into the calcaneus. and identify the flexor digitorum longus. Identify the muscles bounding the fossa. Explore the compartments. locate and identify septa and attachments. Note the relationship to the biceps femoris tendon as the nerve courses around the neck of the fibula. Clear the fat and identify the tibial nerve and its medial sural cutaneous branch. Remove the subcutaneous tissue from the posterior surface of the leg and dissect the superficial posterior compartment. Carefully examine the flexor retinaculum. Define the popliteal fossa. Locate a middle genicular artery entering the posterior side of the knee joint. Where exactly is the popliteal fossa located in the lower extremity? Do you find lymph nodes here? Surface features of the popliteal fossa Popliteal artery and vein Remove the popliteal vein and expose the popliteal artery. Identify the muscular branches to hamstrings and sural branches. Remove the soleus from its fibular attachment and expose the lower portion of the transverse intermuscular septum. . Then locate the superior medial and superior lateral genicular arteries crossing the heads of origin of the gastrocnemius muscles. Now clear the popliteal vein and trace the lesser saphenous vein to its termination. enter the deep posterior compartment. clean and identify its contents. but lying directly on the bone. also identify the common fibular (peroneal) nerve and its lateral sural cutaneous branch. Remove the popliteal fascia (part of what fascia?). In the present and following dissection. Do not trace them into the foot at this time. Define the boundaries of the popliteal fossa. tibialis posterior and flexor hallucis longus muscles.

and calcaneal branches. Significance? Do not trace the posterior tibial artery into the foot. note its muscular branches and its relations behind the medial malleolus. What vessels constitute the collateral blood supply of the knee? . Trace the nerve through the deep posterior compartment and observe its relationship to the posterior tibial artery. Consider actions of muscles of the posterior compartment of the leg. noting muscular. malleolar. Follow the anterior tibial artery to the upper free edge of the interosseous membrane where it passes into the anterior compartment. and note that it divides into anterior and posterior tibial arteries at the lower border of the popliteus muscle. The fibular (peroneal) artery is hidden by the flexor hallucis longus muscle. its course between the two heads of gastrocnemius and its course deep to the origin of the soleus.Trace the blood vessels of the leg. Trace the fibular artery in relation to the interosseous membrane and note its perforating branch. Arteriogram of the popliteal artery Follow the posterior tibial artery. Begin with the popliteal artery. noting branches to superficial posterior compartment muscles. Trace the tibial nerve.