Download - Femoral n
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Femoral n.
• The femoral nerve is the largest branch of the lumbar plexus.
• Femoral nerve is created from contributions from L2, L3, and L4.
• The femoral nerve enters into the thigh under the inguinal ligament, between the psoas and iliacus mucle.
• Nerve of anterior compartment of thigh
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Femoral Nerve “block”
1. Locate the anterior superior iliac spine and the pubic tubercle.
2. Just below this line is the femoral nerve.
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3. Palpate the femoral artery4. The femoral nerve should be
located 1 cm lateral to the palpation
5. Medial to lateral the structures are femoral vein, artery, and nerve (VAN).
IL = inguinal ligament
IC = inguinal crease (a natural skin fold 4–6 cm below the inguinal ligament),
FA = femoral artery
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femoral nerve block
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Femoral Nerve Block• Indications:• 1. Knee surgery• 2. Vascular surgery• • Complications:• 1. Intravascular injection causing systemic toxicity• 2. Hematoma• • Technique:• • Patient Position: Supine• • Landmarks: Insert needle 1cm lateral to the femoral artery. Two “pops” can be felt when
needle passes through fascia lata and fascia iliaca.• • Endpoints: Patellar movement should be detected.
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FEMORAL NERVE INJURY
• Injured by stab or gunshot wound• Motor loss• Loss of knee extension• Sensory loss• On anterior and medial aspect of thigh• Medial side of lower leg• Medial border of foot up to ball of great toe
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INJURY OF LATERAL CUTANEOUS NERVE OF THIGH
• CausesCompression or inflammation • PresentationSharp pain in the course of distribution
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Obturator n.
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Landmark
Cerebral palsy
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OBTURATOR NERVE INJURY• Causes• Penetrating wounds• Anterior dislocation of hip joint• Obturator hernia or tumors• Muscles paralyzed • All the adductor muscles except for hamstring part of adductor
magnus• Motor loss• adduction of thigh• Sensory loss• Medial side of thigh
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Sup. Gluteal n.Infer. Gluteal n.
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INJURY TO SUPERIOR GLUTEAL NERVE
• Loss of abduction of hip• Unilateral injury:
shows positive trendelenberg,s sign• Bilateral injury:
shows waddling gait
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INJURY TO INFERIOR GLUTEAL NERVE
• Impairment of hip extension and lateral rotation
• Difficulty in raising the body from sitting position
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Sciatic n.
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Your homework:
Sciatic Nerve “block”?
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SCIATIC NERVE INJURY
• Commonly injured in following conditions:• I.V.Disc Prolapse• Dislocation of hip joint• Piriformis syndrome• Intramuscular injection
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I.V.Disc Prolapse
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Intramuscular injection
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Dislocation of hip joint
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SCIATICA
• Pain along the sensory distribution of sciatic nerve
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Gluteal Region
Muscles
Arterial Supply
Nerve Supply
Superficial:Gluteus MaximusGluteus MediusGluteus MinimusDeep:PiriformisGemelus SuperiorObterator InternusGemelus InferiorQuadratus Femoris
Superior Gluteal ArteryInferior Gluteal Artery(branches of Internal Iliac a.)
Branches of Sacral Plexus
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Ant. Compartment
Muscles
Arterial Supply
Nerve Supply
SartoriusQuadriceps
Femoral Artery
Femoral nerve
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Post. Compartment
Muscles
Arterial Supply
Nerve Supply
Hamstring:1. Semitendinosus2. Semimembranosus3. Biceps femoris
Profonda femoris:Branch of femoral artery
Sciatic nerve
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Med. Compartment
Muscles
Arterial Supply
Nerve Supply
PectineusAdductorsGracilis
Obturator artery:Branch of internal iliac artery Femoral artery
Obturaror nerve:Branch of Lumbar plexus