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Anatomy

Lower Limb

Question 136 of 180

A 67 year old man presents to the ED complaining of pain and swelling to the posterior knee. On examination you note a tender swelling in the popliteal fossa. The popliteal fossa is bordered superiorly by which of the following muscles:

Answer:

The popliteal fossa is bordered superomedially by the semimembranosus and superolaterally by the biceps femoris.

The popliteal fossa is a diamond-shaped space behind the knee joint.

Table: Anatomical Boundaries and Contents of the Popliteal Fossa

Popliteal fossa Structure(s)
Superomedial border Semimembranosus
Superolateral border Biceps femoris
Inferomedial border Medial head of gastrocnemius
Inferolateral border Lateral head of gastrocnemius and plantaris
Floor Knee joint capsule and adjacent surfaces of femur and tibia and popliteus muscle
Roof Deep fascia
Contents Popliteal artery, popliteal vein, tibial nerve, common fibular nerve

Anatomical boundaries

The popliteal fossa is bordered:

  • superomedially by the semimembranosus
  • superolaterally by the biceps femoris
  • inferomedially by the medial head of the gastrocnemius
  • inferolaterally by the lateral head of the gastrocnemius and plantaris

The floor of the fossa is formed by the capsule of the knee joint and adjacent surfaces of the femur and tibia, and more inferiorly by the popliteus muscle.

The roof is formed by deep fascia.

Original by Henry Vandyke Carter [Public domain], via Wikimedia Commons

Anatomical Boundaries of Popliteal Fossa. (Image by Henry Vandyke Carter [Public domain], via Wikimedia Commons)

Contents

The major structures contained within the popliteal fossa are (from medial to lateral):

  • the popliteal artery
  • the popliteal vein
  • the tibial nerve
  • the common fibular nerve

The small saphenous vein ascends in the superficial fascia on the back of the leg to the knee where it penetrates the deep fascia and enters the popliteal fossa to drain into the popliteal vein. One other structure that passes through the roof of the fossa is the posterior cutaneous nerve of the thigh which descends through the thigh superficial to the hamstring muscles, passes through the roof of the popliteal fossa, and then continues inferiorly with the small saphenous vein to supply skin on the upper half of the posterior leg.

Modified by FRCEM Success. Original by Henry Vandyke Carter [Public domain], via Wikimedia Commons

Contents of Popliteal Fossa. (Image modified by FRCEM Success. Original by Henry Vandyke Carter [Public domain], via Wikimedia Commons)

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  • Biochemistry
  • Blood Gases
  • Haematology
Biochemistry Normal Value
Sodium 135 – 145 mmol/l
Potassium 3.0 – 4.5 mmol/l
Urea 2.5 – 7.5 mmol/l
Glucose 3.5 – 5.0 mmol/l
Creatinine 35 – 135 μmol/l
Alanine Aminotransferase (ALT) 5 – 35 U/l
Gamma-glutamyl Transferase (GGT) < 65 U/l
Alkaline Phosphatase (ALP) 30 – 135 U/l
Aspartate Aminotransferase (AST) < 40 U/l
Total Protein 60 – 80 g/l
Albumin 35 – 50 g/l
Globulin 2.4 – 3.5 g/dl
Amylase < 70 U/l
Total Bilirubin 3 – 17 μmol/l
Calcium 2.1 – 2.5 mmol/l
Chloride 95 – 105 mmol/l
Phosphate 0.8 – 1.4 mmol/l
Haematology Normal Value
Haemoglobin 11.5 – 16.6 g/dl
White Blood Cells 4.0 – 11.0 x 109/l
Platelets 150 – 450 x 109/l
MCV 80 – 96 fl
MCHC 32 – 36 g/dl
Neutrophils 2.0 – 7.5 x 109/l
Lymphocytes 1.5 – 4.0 x 109/l
Monocytes 0.3 – 1.0 x 109/l
Eosinophils 0.1 – 0.5 x 109/l
Basophils < 0.2 x 109/l
Reticulocytes < 2%
Haematocrit 0.35 – 0.49
Red Cell Distribution Width 11 – 15%
Blood Gases Normal Value
pH 7.35 – 7.45
pO2 11 – 14 kPa
pCO2 4.5 – 6.0 kPa
Base Excess -2 – +2 mmol/l
Bicarbonate 24 – 30 mmol/l
Lactate < 2 mmol/l

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