Review article functional popliteal artery entrapment. The popliteal fossa or space is a lozengeshaped space, at the back of the kneejoint. The popliteal fossa sometimes referred to as the hough, 1 or kneepit in analogy to the armpit is a shallow depression located at the back of the knee joint. Editor objectives 1 explain the details of the popliteal and saphenous nerve blocks, including techniques, indications and potential complications. With patients in the supine position, the upper edge of the patella and the groove between the posterior border of the vastus lateralis and the anterior border of the tendon of the biceps femoris were identified.
A cystic mass arising in the popliteal fossa can be either a meniscal cyst, a synovial cyst bakers cyst, or a ganglionic cyst 1. It was tangentially excised, and the resulting defect was closed with a superficial vein patch derived from a local vein c. This article will discuss the anatomical structure and the contents of the popliteal fossa, followed by. Small saphenous vein the small saphenous vein ssv forms part of the superficial venous drainage of the lower limb. Manual muscle testing showed grade 05 flexor hallucis longus strength and grade 25. A 68yearold woman presented at a rural primary health care unit in crete, greece, reporting local symptoms of discomfort in the right popliteal fossa with pain during palpation. Sep 22, 2008 popliteal venous aneurysms are uncommon but potentially fatal vascular disorders.
Start studying popliteal fossa and leg pictures too. Pdf popliteal vessels entrapment by a variant accessory belly of. The space is extremely dynamic, allowing for its neurovascular contents to move during the extreme range of motion produced by knee flexion and extension. This region can develop many clinical complications in the vascular, nervous, lymphatics, adipose. It lies in between laterally lateral intermuscular septum and medially posterior intermuscular compartment which is incomplete. Pdf ultrasound guided sciatic nerve block snb at the popliteal fossa is performed with the lateral approach. Popliteal fossa syndrome advanced therapy institute. A pseudoaneurysm was detected and operated a year later. A small group of popliteal lymph nodes lie alongside the popliteal vein. Popliteal fossa is a diamondshaped hollow found on the rear side of the knee joint.
They participate in the formation of the periarticular. As it gives passage for primary vessels and nerves from the thigh to the leg, this fossa has great anatomical significance. Popliteal synovial cysts, also known as bakers cysts, are a common occurrence in adults and children. Popliteal fossa dissection with narration dr sanjoy sanyal.
Supine with leg abducted and externally rotated transducer. A strain of the tendinous origins of one of the gastrocnemius heads may also be at fault. On the arteriography, the popliteal artery was occluded and the blood flow was maintained with collateral vessels. The popliteal fossa is a common site of lower extremity pain and other symptoms for which imaging evaluation frequently occurs. Most pregnant women experience striae at some point during their pregnancy. The popliteal fossa was explored through a posterior approach through an sshaped incision and the patient underwent tangential aneurysmectomy and lateral venorrhaphy. A patient afflicted with the popliteal fossa syndrome will complain of a great deal of pain behind that knee, usually describing it as a feeling of great pressure and swelling. The popliteal fossa, we looked at the boundaries, the roof, the floor, and we just finished off by looking at the contents of this space. The extra fluid builds up and pushes through the back part of the joint capsule, forming a cyst. This video is a real time dissection of the popliteal fossa with narration, with. Back of thigh and popliteal fossa it extends from lower part of gluteal region to back of knee joint up to popliteal fossa. Popliteal ligament an overview sciencedirect topics. Wedel lateral approach to the sciatic nerve in the popliteal fossa paul j. It is the main path in which structures move from the thigh to the leg.
Vascular injury associated with blunt trauma without. Pdf anatomical approach to clinical problems of popliteal fossa. Popliteal artery aneurysms paas are rare in general population but represent the second most common peripheral arterial aneurysms following those located in the aortoiliac segment. This region consists of the gluteal muscles, the hamstring muscles and several clinically important arteries, veins and nerves. Transverse at the base of the popliteal fossa 4 5cm above popliteal crease needle. Popliteal venous aneurysms are possible sources of embolism. Magnetic resonance imaging mri is useful for the diagnosis. The bones of the popliteal fossa are the femur and the tibia. Because the condition in which the popliteal cyst dissects laterally toward the major nerves and vessels of the popliteal fossa is exceedingly rare in clinical experience and in the literature, most existing publications represent only case reports and short case series and have limited followup. Accurate placement 4 ultrasoundguided peripheral nerve.
Diagnosing a popliteal venous aneurysm in a primary care. Pdf the present case report regards the incidental finding of right. This region can develop many clinical complications in the. Lower limb anatomy popliteal fossa, dr g bhanu prakash duration. The popliteal fascia, which is continuous with the fascia lata superiorly and the fascia crusis inferiorly, forms the roof of the fossa. Chronic expanding hematoma in the popliteal fossa after. Ultrasound evaluation of the symptomatic popliteal fossa. This fossa is limited anteriorly by the distal border of the patellar surface and posteriorly by the intercondylar line, which separates it from the popliteal surface of the femur. The popliteal fossa was explored through a posterior approach.
Limb amputation in popliteal artery injury around the knee joint has been reported to be significantly more frequent than other vessel injuries because of insufficient collateral circulation. Popliteal fossa anatomy mnemonic radiology reference. Learn vocabulary, terms, and more with flashcards, games, and other study tools. Total excision with the pseudocapsule is the treatment method. In the floor adductor magnus and vastus lateralis lies. The evidencebased surgical anatomy of the popliteal artery and the. Mar 02, 2016 the popliteal artery and vein and the tibial and common peroneal nerves pass through the fossa. Thirtyfour patients undergoing ankle or foot surgery were enrolled in this study. This paper will be judged for the resident writers award. It is usually performed in the lateral or prone position. The gluteal region is located posterior to the pelvic girdle and extends downward on the back of the upper part of the leg as the posterior thigh and then the popliteal fossa. Apr 15, 2020 the popliteal fossa is a diamondshaped depression located posterior to the knee joint. Our experience of popliteal vein aneurysm interactive. The popliteal fossa sometimes referred to colloquially as the knee pit, or poplit is a shallow depression located at the back of the knee joint.
It ends at the level of the lower border of the popliteus muscle by dividing into anterior and posterior tibial arteries branches muscular branches articular genicular branches to the knee. We present a case of a 63yearold male who presented with a retained knife blade in the popliteal fossa. Subsequently, angiocomputed tomography act confirmed a 36. The genicular arteries are the superior lateral, superior medial, middle, inferior lateral, and inferior medial genicular arteries. The capsular ligament, oblique popliteal ligament and the infrapatellar synovial fold all attach to the intercondylar line on the posterior femur. Other more unusual conditions such as trauma, congenital popliteal aneurysm, mycotic aneurysm. Aplateral radiographs demonstrated a 3x12 cm retained knife blade in the popliteal fossa. Few nodes just under the deep fascia embedded in the fatty connective tissue of popliteal fossa, close to the popliteal vessels drain the deep tissues of the leg,foot and knee joint efferents to the deep inguinal ln 14. A popliteal cyst is a small, baglike structure that forms when the joint lining produces too much fluid in the knee. Striae or stretch marks result from stretching of the skin, or other influences such as cushing syndrome. The cyst squeezes out toward the back part of the knee in the area called the popliteal fossa, the inden. Tibial neuropathy caused by popliteal pseudoaneurysm. Professor, surgeon, neuroscientist and medical informatician. A cystic mass in the popliteal fossa and its differential diagnosis article pdf available in archives of plastic surgery 424.
Isolated popliteus muscle rupture with neurovascular. Aim to assess the analgesic effect of adding a ppb to. Laterally it is bounded by the biceps femoris above, and by the plantaris and the lateral head of the gastrocnemius below. Wusu, md, natalie casemyr, md, mostafa abousayed, md, malcolm r. Passes into the superficial fascia at the inferior aspect of the popliteal fossa usually intermediate to the medial and lateral heads of the gastrocnemius muscle, travels inferiorly through the leg region usually with the small saphenous vein and passes posterior to. Tibial neuropathy caused by popliteal pseudoaneurysm following total knee arthroplasty. Jan 19, 2016 editor the popliteal block can provide adequate anaesthesia and analgesia for surgery below the knee. To recap the pertinent anatomy of the popliteal fossa. Compression syndromes of the popliteal neurovascular.
To the editor, sciatic nerve blocks are commonly performed in the popliteal fossa by injecting local anesthetic at the level of the major bifurcation of the common sciatic nerve into its common peroneal and tibial branches. Like other flexion surfaces of large joints groin, armpit, cubital fossa and essentially the anterior part of the neck, it is an area where blood vessels and nerves pass. When the knee is fully extended, this area of the anatomy resembles a small bowl nestled into the back of the knee, and as the knee is bent, it folds in on itself. Dec 14, 2012 lower limb anatomy popliteal fossa, dr g bhanu prakash duration. Softtissue popliteal masses can be evaluated using physical examinations and imaging studies, such as computed tomography ct or magnetic resonance imaging mri. When the presenting clinical history includes trauma, evaluation can be straightforward.
When opened, it was seen to be filled with friable thrombus b. The popliteal artery it enters the popliteal fossa on the medial side of the femur. Pdf bakers cyst, or popliteal cyst, is a fluidfilled mass that is a distention of a preexisting bursa in the popliteal fossa, most commonly the. The popliteal fossa borders contents teachmeanatomy. A useful mnemonic to remember popliteal fossa anatomy medialtolateral arrangement is. We hypothesised that a popliteal plexus block ppb as a supplement to an ftb would reduce pain after tka without anaesthetising motor branches from the sciatic nerve in the popliteal fossa. Popliteal venous aneurysm journal of vascular surgery. These lesions may have more or less symptomatic manifestation above all in females and more frequently in people over 40 years 36. This picture shows striae in the popliteal fossa the area on the back side of the leg at the knee joint. Five genicular branches of the popliteal artery supply the capsule and ligaments of the knee joint. Ultrasound us usually begins the workup for cause of symptoms.
T h e p o p l i t e a l a r t e r y at the middle of the fossa the popliteal artery is. Popliteal fossa syndrome the popliteal fossa syndrome is a pain syndrome of unknown cause or etiology. Like other flexion surfaces of large joints, it is an area where blood vessels and nerves pass relatively superficially, and with an increased number of lymph nodes. The needle was directed posteriorly with a 2030degree sign angle. Structures within the popliteal fossa include from superficial to deep tibial nerve. Popliteal artery the popliteal artery is the direct continuation of the superficial femoral artery, at the point where it exits the adductor canal at the adductor. Softtissue popliteal masses can be evaluated using physical examinations and imaging studies, such as computed tomography ct or.
Popliteal fossa definition of popliteal fossa by medical. Pronunciation of popliteal fossa with 2 audio pronunciations, 1 meaning, 10 translations and more for popliteal fossa. Popliteal venous aneurysms pvas may cause fatal complications e. This dense fascia is reinforced by transverse fibres and forms a protective sheath for the structures passing through the fossa. The popliteal fossa is formed in the posterior knee of the biceps femoris muscle superolaterally, the semitendinosus superomedially, and the lateral and medial heads of the gastrocneumius inferiorly.
A strain of one or more of the distal hamstring tendons is the most likely culprit. Knee pain is more common in the anterior, medial, and lateral aspect of the knee than in the posterior aspect of the knee. Important nerves and vessels pass from the thigh to the leg by traversing through this fossa and the muscles of the thigh and the leg form its boundaries. The popliteal fossa is a shallow depression located at the back of the knee joint. Pdf medial approach to the sciatic nerve at the popliteal fossa in. The popliteal artery and vein and the tibial and common peroneal nerves pass through the fossa. We report a case of a 21yearold man with a popliteal venous aneurysm.
A cystic mass in the popliteal fossa and its differential. Jul 14, 2015 a cystic mass arising in the popliteal fossa can be either a meniscal cyst, a synovial cyst bakers cyst, or a ganglionic cyst. They can be symptomatic or asymptomatic, mimicking different conditions. A large personal experience on the surgical treatment of such a disease 29 cases in 22 patients allowed us to focus on the optimal diagnostic procedure useful to detect this problem at an early stage. They present as swelling in the popliteal fossa due to enlargement of the gastrocnemiussemimembranosus bursa, which lies between these two muscles on the medial side of the fossa slightly distal to the center crease in the back of the knee. Lateral approach to the sciatic nerve in the popliteal fossa. Contents gluteal region and posterior thigh by james pickering, phd is from the course lower limb anatomy. The patient was placed in a knee immobilizer and taken to surgery where the blade was extracted from a medial incision along the junction of the vastus medialis and sartorius. The differential diagnoses for posterior knee pain include pathology to the bones, musculotendinous structures, ligaments, andor to the bursas.
Anatomical approach to clinical problems of popliteal fossa. Pierces the deep fascia and drains into the popliteal vein. Pseudoaneurysms result from arterial wall disruptions and can be mistaken for ceh. Bhanu prakash usmle, fmge and neet pg 108,071 views. The con tents of the popliteal fossa include the popliteal artery, popliteal vein, small saphen ous vein, tibial nerve, the co mmon peron eal ner ve, and the common fibular n erve. The popliteal fossa or knee pit is a depression at the back of the knee. The deepest structure in the fossa, the popliteal artery runs close to the joint capsule of the knee as it spans the intercondylar fossa. Thorough understanding of the appearance and location of the popliteal fossa masses one can reach a specific differential diagnosis in the majority of cases.
Injections near this branch point have the advantage that they are. Immediately a er the test is performed, the popliteal fossa is again auscultated for a. This study proved that friction to the popliteal fossa is effectively sic enhances venous flow by increasing the blood flow velocity in the popliteal vein. After surgery, a gradually expanding mass recurred in his popliteal fossa. Hematomas caused by surgery or trauma that persist and expand slowly for more than a month are defined as chronic expanding hematomas ceh. Popliteal venous aneurysms are uncommon but potentially fatal vascular disorders.
Feb 05, 2017 educational video created by dr sanjoy sanyal. Its very easy to palpate this area of the anatomy and find its boundaries by reaching down and feeling behind the knee, for those who are curious. Popliteal fossa, also known as the popliteal space, is located behind the knee joint. Popliteal fossa orthopaedicsone articles orthopaedicsone. They usually affect men over 60 years old with established cardiovascular disease caused by atherosclerosis. Effects of friction massage of the popliteal fossa on blood. The analgesic effect of a popliteal plexus blockade after.
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