nerves of the lower limb

8/12/2019 Nerves of the Lower Limb

1/8

NERVES OF LOWER LIMB AND THEIR INJURIES

LEARNING OBJECTIVES

At the end of lecture students should be able to

Know the names of nerves and their main branches innervating lower limb

Know the nerves closely related to a bone or other structure of lower limb

Know the main nerves commonly vulnerable to injury

Know the main area and loss of function if particular nerve is injured

Define and under stand terms neuritis, anesthesia, par aesthesia, paralysis, neuralgia,

sciatica


2/8

NERVES OF LOWER LIMB

Arise from lumbar and sacral plexus

Main nerves of lumbar plexus are 1. emoral nerve

!. "bturator nerve #. $ateral cutaneous nerve of thigh

Main nerves of sacral plexus are 1. %uperior gluteal nerve

!. &nferior gluteal nerve

#. 'udendal nerve

(. %ciatic nerve which terminates in popliteal fossa into a. )ibial nerve

b. *ommon peroneal nerve

FEMORAL NERVE L2,3,4

+ranch of lumbar plexus

erve of anterior compartment of thigh

Arise in abdomen, -nters thigh behind inguinal ligament lateral to femoral artery, ! inch

below inguinal ligament divides into anterior and posterior divisions

Anterior i!i"ion

M#"$#%&rbranches sartorius, 'ectineus

C#t&neo#"

Medial cutaneous nerve of thigh

&ntermediate cutaneous nerve of thigh

'o"terior i!i"ion

C#t&neo#"%aphenous nerves/in of Anteromedial surface of leg, medial border of

foot upto ball of great toe

M#"$#%&r ( 0uadriceps femoris

Arti$#%&rto hip and /nee joint

FEMORAL NERVE INJUR)

*omplete division is rare

&njured by stab or gunshot wound

M#"$%e" *&r&%+e

uadriceps femoris

Motor %o""

$oss of /nee extension

Sen"or+ %o""

"n anterior and medial aspect of thigh

Medial side of lower leg


3/8

Medial border of foot upto ball of great toe

OBTURATOR NERVE

OBTURATOR NERVE INJUR)

C"e"

'enetrating wounds

Anterior dislocation of hip joint

"bturator hernia

M#"$%e" *&r&%+e

All the adductor muscles except for hamstring part of adductor magnus

Motor %o""

adduction of thigh

Sen"or+ %o""

Medial side of thigh

LATERAL CUTANEOUS NERVE OF THIGH L2,3

+ranch of lumbar plexus

-nter thigh behind lateral end of inguinal ligament

Divides into anterior and posterior branches

Di"tri-#tion

$ateral aspect of thigh and /nee

$ower lateral 0uadrant of gluteal region

INJUR) OF LATERAL CUTANEOUS NERVE OF THIGH L2,3

C"e"

*ompression or inflammation

're"ent&tion

%harp pain in the course of distribution

OBTURATOR NERVE

Adductor

magnus

adductor part

adductor brevis

Knee joint

Popliteal

artery

Posterior division

ip joint

pectineus

Adductor longus

Adductor brevis

gracilis

!ubsartorial ple"us

#emoral artery

$% $& $'

Anterior division

Adductor

region o(

t)ig)

pelvis

abdomen


4/8

SU'ERIOR GLUTEAL NERVE

+ranch of sacral plexus

-nters gluteal region from pelvis through greater sciatic

foramen above piriformis

2uns between gluteus medius and minimusM#"$%e" inner!&te

3luteus medius

3luteus minimus

)ensor fascia lata

INJUR) TO SU'ERIOR GLUTEAL NERVE

M#"$%e" *&r&%+e

3luteus medius

3luteus minimus

Motor %o""

$oss of abduction of hip Uni%&ter&% in.#r+shows lipping gait and *o"iti!e

trene%en-er/," "i/ni.e. Drooping of pelvis on one side when

ipsilateral foot is lifted off the ground

Bi%&ter&% in.#r+ shows0&%in/ /&it

INFERIOR GLUTEAL NERVE

In1erior /%#te&% ner!e

+ranch of sacral plexus

-nter gluteal region from pelvis through greater sciatic

foramen below piriformis

2uns between gluteus maximus and medius

Muscle innervated

3luteus maximus

INJUR) TO INFERIOR GLUTEAL NERVE

M#"$%e *&r&%+e

3luteus maximus muscle

Motor %o""

&mpairment of hip extension and lateral rotation

Difficulty in raising the body from sitting or stooping

position


5/8

SCIATIC NERVE INJUR)

*ommonly injured in following conditions

IVDi"$ 'ro%&*"e

Di"%o$&tion o1 i* .oint

'iri1ori" "+nroe

Intr"$#%&r in.e$tion

'enetr&tin/ 0o#n &n 1r&$t#re o1 *e%!i"

Most lesions are incomplete456 cases involve common peroneal due to superficial position

$'$*

!+ !%!&

,$UTEA$ RE,-ON

BA.K O# T-,

$O/ER

$E,

#OOT

!A.RA$ P$E0U!

.O11ON PERONEA$

NERVE

!.-AT-. NERVE

B-.EP! #E1OR-! !ORT EA2

KNEE 3O-NT

!K-N O# $ATERA$

$E,

$ATERA$

.UTANEOU! O#

$E, !UPER#-.-A$

PERONEA$

2EEP

PERONEA$

PERONEU!

$ON,U! AN2

BREV-!

!K-NO#

$E,

!K-N O# .$E#T

BET/EEN #-R!T %

TOE!

1U!.$E! O#

#RONT O# $E,

ANK$E 3O-NT

E0TEN!OR

2-2-TORU1

BREV-!

!K-N O# $ATERA$

!-2E O# #OOT

AN2 $-TT$E TOE

!K-N O# 2OR!U1

!.-AT-. AN2 .O11ON PERONEA$ NERVE

!.-AT-. NERVE AN2 T-B-A$ NERVE

$*$* !+ !%

!& PE$V-!

,$UTEA$

RE,-ON

BA.K O# T-,

$O/ER $E,

!O$E O# #OOT

)ip joint

To all )amstrings muscle

Knee joint

1uscles o( bac4 o( leg !ural nerve

1edial plantar

nerve

Abductor )allucis

#le"or )allucis and

digitorum brevis

-stlumbrical

!4in and

joints o(

sole

All ot)er

muscles

o( sole

!4in o(

sole

$ateral plantar nerve

!.-AT-.

NERVE

T-B-A$ NERVE


6/8


7/8

foot drop due to weight of foot.

SCIATIC NERVE INJUR)

Sen"or+ %o""

All sensation below /nee below the /nee except the medial aspect of leg and foot

upto ball of big toe. $oss of sensation of sole ma/es the patient vulnerable to trophic ulcers

SCIATICA

'ain along the sensory distribution of sciatic nerve

'osterior aspect of thigh

'osterior and lateral sides of leg

$ateral part of foot

C"e"

'rolapse of intervertebral disc

&ntrapelvic tumor

&nflammation of sciatic nerve

INJUR) TO COMMON 'ERONEAL NERVE

C"e

racture of fibular nec/, entrapment by leg casts or splintsM#"$%e" *&r&%+e

Anterior and lateral muscles of leg

De1orit+

-0uinovarus foot is plantar flexed and inverted due to actions of

unopposed plantar flexors and invertors.

INJUR) TO COMMON 'ERONEAL NERVE

Sen"or+ %o""

Anterior and lateral side of leg

Dorsum of foot and digits

Medial side of big toe

$ateral border of foot and lateral side of little toe along with medial border uptothe ball of great toe is unaffected

INJUR) TO TIBIAL NERVE

C"e 2arely injured in fractures of upper end of tibia or penetrating

woundM#"$%e *&r&%+e

All muscles of bac/ of leg and sole

De1orit+

*alcaneovulgus Dorsiflexion and -version of foot


8/8

INJUR) TO TIBIAL NERVE

Sen"or+ %o""

9hole of the sole of foot

May result into trophic ulcers

nerves of the lower limb

Documents