LumbosacralPlexus

LumbarPlexus
formedfromtheventral ramiofnervesL1L4and somefibersfromT12, forming
iliohypogastricnerves ilioinguinalnerve genitofemoralnerve lateralfemoralcutaneous nerve femoralnerve saphenousnerve obturatornerve
nextslide

CutaneousInnervationofLumbar Plexus

LateralFemoral CutaneousNerve
lateralfemoralcutaneous nervesomatosensoryonlyto skinoflateralaspectofthigh.

Femoralnerve
largestbranchoflumbarplexus motorandsomatosensroy skinofanteriorandlateral thigh,mediallegandfoot anteriormusclesofthighand extensorsoflegiliacus, psoasmajor,pectineus, quadricepsfemoris(rectus femoris,vastusintermedius, vastuslateralisandvastus medialis),andsartorius

iliacus

FemoralNerve(cont)
Itisinthefemoraltrianglewhere thefemoralnerve,overlyingthe iliacusmuscel,thatthenerve dividesintoitsmuscularand sensorybranches. Onlythesaphenousnerve branchenterstheadductor canal,alongwithabranchtothe vastusmedialismuscle.

psoas

pectineus

sartorius
rectusfemoris

adductorlongus

FemoralNerve Innervates musclesofthe AnteriorThigh Action:Flexhip, extendknee

Injurytonerve:Weaknessofhipflexion,lossofknee extension(nopatellarreflex),sensorylosson anteromedialthigh,knee,leg,andfoot

adductorcanal

adductorhiatus

Anteriorthighcompartment musclesinnervatedbythe femoralnerve

SaphenousNerve
formedfromtheposterior divisionofthefemoral nerve isthelargestcutaneous branchofthefemoral nerve. innervatesskinofmedial aspectsoflegandfoot: kneejoint

ObturatorNerve
sensoryinnervations skinofsuperior medialthigh motorinnervation adductormusclesof leg:externaloblique, pectineus,adductor longus,adductor brevis,adductor magnus,andgracilis

iliohypogastricnerve
formedbyfibresfromL1, withsomecontribution fromT12. runsobliquelyacrossthe quadratuslumborum musclebehindthekidney sensoryinnervationskin ofanteriorabdwall Motorinnervation internalandexternal obliquesand transversusabdominis
1.Subcostalnerve2.Iliohypogastricnerve3.Ilioinguinalnerve 4.Lateralcutaneousnerveofthethigh5.Femoralnerve6.Genitofemoralnerve 7.Obturatornerve

ilioinguinalnerve
formedincommonwith theiliohypogastricnerve. sensoryinnervationskin ofuppermedialthigh malescrotumandrootof penisfemalelabia majora motorinnervationjoins iliohypogastricnerveand innervatesthesame muscles
1.Subcostalnerve2.Iliohypogastricnerve3.Ilioinguinalnerve 4.Lateralcutaneousnerveofthethigh5.Femoralnerve6.Genitofemoral nerve7.Obturatornerve

GenitofemoralNerve
formedfromL1,2and passesthroughthepsoas toemergeonitsanterior surface. runsdownwardsonthe psoasanddividesinto genitalandfemoral branches. sensoryinnervationskin ofmiddleanteriorthigh malescrotumand cremastermuscle femalelabiamajora
1.Subcostalnerve2.Iliohypogastricnerve3.Ilioinguinalnerve 4.Lateralcutaneousnerveofthethigh5.Femoralnerve6.Genitofemoralnerve 7.Obturatornerve

CremasterMuscle
Cremasteractsto retractthetestes. Thisfunctionsto keepthetestes warmandprotect frominjury. itisanextension oftheinternal obliquemuscle Thecremasteric reflexisaclinical testofthe muscle.

SacralPlexus
NerverootsfromL4 S3mergetoformthe sacralplexus

 Aftermerging,the sacralplexus passesthrougha boneynotchin thepelvisknown astheGreater SciaticNotch (GreaterSciatic Foramen). Itisherethatthe sciaticnervegets itsname.

Next,itpassesunderorthrougha musclecalledthePiriformisMuscle Here,itdividestoformthe lateralcommonperonealsupplies fibrestotheshortheadofbiceps femoris. medialtibialdivisionssuppliesthe semimembranosus, semitendinosus,theischialheadof adductormagnusandlongheadof bicepsfemoris

Intheglutealregionthenerveliesdeep togluteusmaximus,betweenthe

GreaterTrochanterofthefemur andtheischialtuberosity.

Thesciaticnervethenpasses posteriortotheadductor magnusandbetweenthe hamstringmuscles(posterior compartmentmuscles),where thetibialpartinnervates:

semitendinosis semimembranosis bicepsfemoris(longhead

Tobecalledahamstring,the musclemustarisefromthe ischialtuberosity.

Asthesciaticnervereachesthe posteriorknee(poplitealfossa)it physicallydividestoformthe Tibialnerve CommonPeronealnerve. TheTibialnervegetsitsname becauseitfollowstheTibialbone andCommonPeronealduetoits softtissuelocationattheouterleg region.

PoplitealFossa
Withthenervesandarteriesremovedand themusclesreflected,younowidentifythe structuresmakingupthefloorofthe poplitealfossa: posteriorsurfaceoffemur posteriorsurfaceoftibia obliquepoplitealligament popliteusmuscle

Nervesofthe PolitealFossa
Themusclesandcontentsofthepopliteal fossaare: Muscles semitendinosus bicepsfemoris medialheadofgastrocnemius lateralheadofgastrocnemius Arteries poplitealarterycontinuationoffemoral artery superiormedialandlateralgenicular arteries inferiormedialandlateralgenicular arteries

Nerves
tibialnerve commonperonealnerve

1.SciaticNerve 2.TibialNerve 3.CommonPeroneal nerve(FibularNerve)

PoplitealFossa
semitendinosus semimembranosus bicepsfemoris

lateral medial

lateral,medialheadof gastrocnemius

 Commonperonealnerve
passessuperficialtotheneckofthe fibula,whereitissubcutaneousand vulnerabletoinjury Severenceofthisnervecausesparalysis ofallthemusclesoftheanteriorand lateralcompartments(dorsiflexorsofthe ankleandevertorsofthefoot).Thelossof eversionofthefootanddorsiflexionofthe anklecausesfootdrop. Branches: Superficialperonealnervelateralleg compartmentperoneusbrevis,peroneus longus DeepperonealnerveThisisthenerveof theanteriorlegcompartment.
Tibialisanterior,Extensorhallucislongus, Extensordigitorumlongus,Fibularis (peroneus)tertias Dorsiflexionoffoot,extensionoftoes

LateralCompartment
alsocalledtheperonealcompartment ismadeupoftwomuscleswhose tendonscrosstheanklejointposteriorto andunderthelateralmalleolus.This makesthemflexorsofthefoot.These musclesarethe: peroneuslongus peroneusbrevis

Superficialperoneal NerveoftheLateral Compartment

Thesuperficialperonealnervebranches fromthecommonperonealnervenear theneckofthefibulaandpasses betweentheperoneuslongusandbrevis muscles,atwhichpointtheysupplythe muscles.Thesuperficialbranchthen continuesontothedorsumofthefootto supplytheskinthere.

ArteriesoftheLateralLeg Thearteriestothetissuesinthisregionarefromboth theanteriorandposteriortibialbranchesofthepopliteal artery.

AnteriorLegCompartment
Theanteriorcompartmentcontainsmusclesthatare basicallyextensorsoftheankleandtoes.Theyinclude: tibialisanterior extensordigitorumlongus extensorhallucislongus

DeepPeronealNerveofthe AnteiorCompartment
Thenerveoftheanteriorcompartmentofthelegisthe deepperonealnerve.Thisnerveterminatesbetweenthe bigtoeandsecondtoeandcanbetestedatthispoint.

Thearteryoftheanteriorcompartmentofthelegistheanteriortibialartery whichisabranchofthepoplitealartery.Itsterminalbranch,thedorsalispedis, canbepalpatedonthedorsumofthefootbetweenthe1stand2ndmetatarsal bones.

OtherSacralNerves:

InternalPudendalNerve
S2,S3,S4jointoform thepudendalnervethat suppliesstructuresin theperineum.

OtherSacralNerves:

PosteriorCutaneousFemoralNerve
arisesfromtheposteriordivisionsofthe ventralramiofS1andS2andthe anteriordivisionsofS2andS3. Itsuppliesmoreskinthatanyother cutaneousnerve. skinoftheinferiorofthebuttock skinoftheperineum. posteriorthighandproximalpartof theleg.

OtherSacralNerves:

SuperiorandInferiorGlutealNerve
DeepGlutealMuscles(musclesthat movethethigh)Gluteusminmus(SG),
glutealmaximus(IG),glutealmedius (SG),pirisformis(SG,IG),gemellus superior(IG),obturatorinternus,obturator externus,gamellusinferior,quadratus femoris

SciaticNerveSummary
OriginatesfromL4S3 Sciaticnerveiscomprisedofthetibialandcommonfibularnerves, runninginacommonepineurium

Landmark:Withinthepelvis,thesciaticnerveliesimmediatelyanterior tothepiriformis

Landmark:Sciaticnerveemergesfromthepelvisviathegreatersciatic foramen,usuallyinferiortothepiriformisanddeeptothegluteus maximus

Motor(tibialnerve):Posteriorcompartmentofthethigh Exception:shortheadofbicepsfemorisisinnervatedbythe commonfibularnerve Musclesoftheposteriorcompartmentofthethigh Action:Extendhip,flexknee Branches:Tibialnerveandcommonperonealnerve

Injurytonerve:Lossofallmotorinnervationtoposteriorthigh,anterior andposteriorleg,andfoot Clinicalfeatures:Flailfoot

SciaticNerve
largestnerveinthe body madeupofnerve rootsfromthe4th lumbarvertebratothe 3rdsacralvertebra.

femoraltriagule Theadductorcanalservesasa conduitthroughwhichvessels passfromthefemoraltriangleto theposterioraspectoftheknee poplitealfossa femoralartery,vein,and nerve saphenousnerve nervetovastusmedialis

adductorcanal