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LUMBOSACRAL PLEXUS
Lufukuja G. 1
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Lumbar plexus (T12- L4):
Lumbar Plexus
• Femoral nerve:
L2—L4.Largest branch of lumbar plexus.Emerges from lateral side of psoas major.
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Lumbar Plexus
• Femoral nerve:
Enters thigh behind inguinal ligament.Supplies:
In iliac fossa:Iliacus (GSE); pectineus (GSE);
femoral artery (GVE).
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Lumbar Plexus
• Femoral nerve:
Supplies:Distally:
Sartorius; quadriceps femoris; anterior thigh (GSA).
Terminates as:Saphenous nerve (GSA) to medial thigh and foot.
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Lumbar Plexus
• Obturator nerve:
L2..L4.Emerges from medial side of psoas major.Descends along lateral wall of pelvis.
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Lumbar Plexus
• Obturator nerve:
Enters thigh through obturator foramen:In obturator groove it divides into:
Anterior branch (anterior to adductor brevis).Posterior branch (posterior to
adductor brevis).
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Lumbar Plexus
• Obturator nerve:
Supplies:Medial thigh muscles (GSE).Skin on medial thigh (GSA).
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Sacral Plexus
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Sacral Plexus
• Superior gluteal nerve:
L4..S1.Passes through greater sciatic notch above piriformis.Supplies lateral gluteal compartment.
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Sacral Plexus
• Inferior gluteal nerve:
L5..S2.Passes through greater sciatic notch below piriformis.Supplies posterior gluteal compartment.
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Sacral Plexus
• Posterior femoral cutaneous:
Runs with gluteal nerves deep to gluteus maximus.
Then runs with sciatic nerve and gluteal artery.
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Sacral Plexus
• Posterior femoral cutaneous:
Supplies:Skin on buttock (GSA) via inferior cluneal
nerve.Skin of external genitalia (GSA) via perineal branches.Skin on back of thigh.
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Sacral Plexus
• Nerves to lateral thigh compartment:
To inferior gemellus (GSE):L4..S1.
To quadratus femoris (GSE):L4..S1.
To piriformis (GSE):S1..S2.
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Sacral Plexus
• Sciatic nerve:
Fusion of:Common peroneal (fibular).Tibial.
Largest physical nerve in the body.
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Sacral Plexus
• Sciatic nerve:
Exits pelvis through greater sciatic foramen:Inferior to piriformis (usually).
Descends between gluteus maximus.Between greater trochanter and ischial
tuberosity.Lies on:
Ischium, gemelli, obturator internus, quadratus femoris.
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Nerve Injuries
• Peripheral:
All motor function and sensation supplied by nerve distal to injury is lost.Total muscle function is lost.Sensation over more than one dermatome is lost.
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Nerve Injuries
• Nerve root:
Usually affected by disc herniation immediately cranial (superior) to it.
Sensory impairment over one dermatome.Muscle weakening.May only affect one root or the other.
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Lumbar Plexus
• Femoral nerve• Cutaneous branches
• Thigh, leg, foot (e.g. saphenous nerve)• Motor branches
• Anterior thigh muscles (e.g. quadriceps, sartorius, iliopsoas)
• Obturator nerve• Sensory
• Skin medial thigh; hip, knee joints• Motor
• Adductor muscles• Lateral femoral cutaneous
• Sensory• Skin lateral thigh
• Genitofemoral • Sensory
• Skin scrotum, labia major, anterior thigh• Motor
• Cremaster muscle
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Sacral plexus (L4-S4)
Sciatic nerve (L4-S3)
Tibial nerve
Common peroneal (fibular) nerve
Motor to muscles of pelvis and lower extremity (gluteal, posterior femoral, lower leg & foot)Sensory from posterior pelvis, posterior thigh, anterior, posterior & lateral leg
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femurmedial
lateral
Anterior compartment-
Extensors of the knee
Femoral Nerve
Medial compartment-
Adductors of the knee
Obturator Nerve
Posterior compartment-
Flexors of the knee
Sciatic Nerve
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L2
L3
L4
iliopsoas
Rectus femoris
pectineus
Vastus medialis
Vastus intermedius
sartorius
Vastus lateralis
Motor Branches of the
Femoral Nerve
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Adductus magnus
gracilis
Adductor longus
Adductor brevis
Motor Branches of the
Obturator Nerve
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L4
L5
S1
S2
S3
Semitendinosis
Biceps femoris
semimembranosus
Ham
stri
ng
s
Gastrocnemius and posterior compartment of the leg and foot
Tibial nerve
Common peroneal nerve Deep
peroneal nerve Anterior
compartment of leg
Lateral compartment of leg
Superficial peroneal nerve
Motor Branches of the
Sciatic Nerve
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Dermatomes (innervation of skin)
Dermatomes
(area of skin innervated by the cutaneous branches from a
single spinal nerve is called a dermatome)
Reveal sites of damage to spinal
nerves or spinal cord
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