Sacral Plexus

Course code: A2A811
Course Name: Anatomy 2

Sacral Plexus
Learning outcomes:
*Nerves
*Branches
*Motor and sensory functions
Dr Mehreen Jabbar,PT
SACRAL PLEXUS
 The sacral plexus is a network of nerve fibres

that supplies the skin and muscles of the pelvis
and lower limb.
 It is located on the surface of the posterior
pelvic wall, anterior to the piriformis muscle.

 The plexus is formed by the anterior
rami (divisions) of the sacral spinal nerves S1,

S2, S3 and S4. It also receives contributions
from the lumbar spinal nerves L4 and L5.
BRANCHES
 Theanterior rami of the S1-S4 spinal roots

(and the lumbosacral trunk) divide into several
cords. These cords then combine together to
form the five major peripheral nerves of the
sacral plexus.
Cont..
These nerves then descend down the posterior
pelvic wall. They have two main destinations:
 Leavethe pelvis via the greater sciatic foramen –

these nerves enter the gluteal region of the
lower limb, innervating the structures there.
 Remain in the pelvis – these nerves innervate

the pelvic muscles, organs and perineum.
Superior Gluteal Nerve
 The superior gluteal nerve leaves the pelvis
via the greater sciatic foramen, entering the
gluteal region superiorly to the piriformis
muscle.
 It
is accompanied by the superior gluteal
artery and vein for much of its course.
 Roots: L4, L5, S1.

 Motor Functions: Innervates the gluteus
minimus, gluteus medius and tensor fascia
lata.
 Sensory Functions: None.
A useful memory aid for the major branches of

the sacral plexus is
‘Some Irish Sailor Pesters Polly’. This stands
for Superior Gluteal, Inferior Gluteal, Sciatic,
Posterior cutaneous nerve of
thigh, Pudendal.
Inferior Gluteal Nerve
 The inferior gluteal nerve leaves the pelvis via
the greater sciatic foramen, entering the
gluteal region inferiorly to the piriformis
muscle.
 It is accompanied by the inferior gluteal artery
and vein for much of its course.

 Roots: L5, S1, S2.
 Motor Functions: Innervates gluteus
maximus.
 Sensory Functions: None.
Sciatic Nerve
 Roots: L4, L5, S1, S2, S3
 Motor Functions:
◦ Tibial portion – Innervates the muscles in the
posterior compartment of the thigh (apart
from the short head of the biceps femoris),
and the hamstring component of adductor
magnus.
◦ Innervates all the muscles in the posterior
compartment of the leg and sole of the foot.
Cont..
 Common fibular portion – Short head of
biceps femoris, all muscles in the
anterior and lateral compartments of the
leg and extensor digitorum brevis.
Posterior Femoral Cutaneous
 The posterior cutaneous nerve of thigh
leaves the pelvis via the greater sciatic
foramen, entering the gluteal region
inferiorly to the piriformis muscle. It
descends deep to the gluteus maximus
and runs down the back of the thigh to
the knee.
 Roots: S1, S2, S3

Cont..
 Motor Functions: None
 Sensory Functions: Innervates the skin

on the posterior surface of the thigh and
leg. Also innervates the skin of the
perineum
Pudendal Nerve
 Thisnerve leaves the pelvis via the
greater sciatic foramen, then re-enters
via the lesser sciatic foramen. It moves
anterosuperiorly along the lateral wall of
the ischiorectal fossa, and terminates by
dividing into several branches.
 Roots: S2, S3, S4

Cont..
 Motor Functions: Innervates the skeletal
muscles in the perineum, the external
urethral sphincter, the external anal
sphincter, levator ani.
 Sensory Functions: Innervates the penis
and the clitoris and most of the skin of

the perineum.
Other Branches
In addition to the five major nerves of the sacral
plexus, there are a number of smaller branches.
These tend to be nerves that directly supplying
muscles (with the exception of the perforating
cutaneous nerve, which supplies the skin over the
inferior gluteal region and the pelvic splanchnic
nerves, which innervate the abdominal viscera):
 Nerve to piriformis
 Nerve to obturator internus
 Nerve to quadratus femoris
Clinical Relevance - Lumbosacral Plexopathy
A lumbosacral plexopathy is a disorder affecting

either the lumbar or sacral plexus of nerves.
They are rare syndromes, caused by damage to
the nerve bundles.
A plexopathy is suspected if the symptoms

cannot be localised to a single nerve. Patients
may complain of neuropathic pains, numbness
or weakness and wasting of muscles.
 One of the main causes of lumbosacral plexopathy
is diabetic amyotrophy, also known as lumbosacral
radioplexus neurophagy. In this condition, the high
blood sugar levels damage the nerves.
 Idiopathic
plexopathy is another cause, being the
lumbosacral equivalent of Parsonage-Turner
syndrome (which affects the brachial plexus).
 Tumoursand other local invasions can cause the

plexopathy due to the compression of the plexus.
RX
Treatment depends on what is causing the
symptoms.
 For tumours and space-occupying lesions,
they should be removed if possible.
 Fordiabetic and idiopathic causes,

treatment with high-
dose corticosteroids can be useful.
Reference:
 Snell’s Neuro anatomy
 Google images
Thank You

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Course code: A2A811

Course Name: Anatomy 2

 The sacral plexus is a network of nerve fibres

pelvic wall, anterior to the piriformis muscle.

rami (divisions) of the sacral spinal nerves S1,

 Theanterior rami of the S1-S4 spinal roots

 Leavethe pelvis via the greater sciatic foramen –

 Remain in the pelvis – these nerves innervate

 Roots: L4, L5, S1.

A useful memory aid for the major branches of

and vein for much of its course.

 Roots: S1, S2, S3

 Sensory Functions: Innervates the skin

 Roots: S2, S3, S4

and the clitoris and most of the skin of

A lumbosacral plexopathy is a disorder affecting

A plexopathy is suspected if the symptoms

 Tumoursand other local invasions can cause the

they should be removed if possible.

 Fordiabetic and idiopathic causes,

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